The National Cholesterol Education Program periodicallyproduces Adult Treatment Panel (ATP) updates as warranted bycurrent clinical scientific research in cholesterol management.1Each of the guideline reports, ATP I, II, and III, has a major rolein guiding physicians how to treat abnormal cholesterol levels.Recent clinical trials demonstrate that LDL-lowering therapywith statins (HMG-CoA inhibitors) reduces total mortality,coronary mortality, major coronary events, coronary proceduresand strokes in patients with established coronary heart disease.1However, the ATP III has cited active or chronic liver disease as anabsolute contraindication to the use of statins. The reason for thiscontraindication goes back to the initial clinical trials of Lipitor(atorvastatin), which demonstrated that persistent elevations (> 3times the upper limit of normal) in serum transaminases occurredin 0.7% of patients who received atorvastatin. The incidence ofthese abnormalities was 0.2%, 0.2%, 0.6% and 2.3% for 10, 20, 40and 80 mg atorvastatin, respectively.2 Based on this information,the recommendation held that liver function tests should beperformed before the initiation of treatment with statins, followingeach dosage increase, and periodically thereafter.