AKT-0153

AKT-0153

A 49-year-old male with type 2 diabetes presents for review. He has a past medical history of hypertension, migraine, and obesity (BMI is 38). Currently, he takes metformin 1 g BD and ramipril 5 mg OD for blood pressure control. His latest HbA1c is 50 mmol/mol, and his total cholesterol is 5.2 with an LDL cholesterol of 3.5. His QRisk2 score is 21%.

During the consultation, you discuss the addition of lipid-lowering medication to reduce his cardiovascular risk, especially in light of his recently treated hypertension. You both agree that starting him on Atorvastatin 20 mg at night is an appropriate treatment for primary prevention of cardiovascular disease.

Before prescribing the medication, you review his latest blood results, which show normal full blood count, renal function, and thyroid function. However, his liver function tests reveal an ALT of 106 IU/L (<60) and an ALP of 169 IU/L (20-200). Bilirubin levels are within normal limits. Upon further investigation, you discover that the ALT rise has persisted since his first blood tests at the surgery over four years ago. However, the liver function results have remained stable over this time, showing no significant variation from the current values. A liver ultrasound done two years ago reports some evidence of fatty infiltration only. What is the most appropriate management strategy for this patient?