A CALL for closer monitoring of a cholesterol-lowering drug was last week made by a coroner in Okehampton. It came at an inquest into the death of an Okehampton man who developed severe liver failure weeks after being prescribed a drug to lower his cholesterol levels. Recording a misadventure verdict, coroner Dr Elizabeth Earland heard that Ivor Meacher, a 71-year-old retired industrial chemist, had been prescribed the drug Atorvastatin in May last year. Okehampton GP Timothy Watson told the inquest an angiogram had revealed Mr Meacher was suffering from coronary heart disease. Blood tests showed his cholesterol levels were raised, so in addition to beta blockers and aspirin, he prescribed a 20mg dose of the cholesterol-reducing drug Atorvastatin. Dr Watson said at the time the drug was prescribed, Mr Meacher?s liver was normal, according to the blood tests. He said Mr Meacher was warned of ?extremely rare? side effects of the drug, which could include liver damage. Dr Watson said: ?I have been prescribing Atorvastatin for about seven years. In my experience, it is very effective in lowering cholesterol levels, further reducing the risk to patients of coronary heart disease.? The inquest heard that by June 18, Mr Meacher was admitted to the Royal Devon and Exeter Hospital after going ?a deep yellow colour?. Blood tests showed his liver functions were ?grossly abnormal?. In a report to the inquest, Dr John Wong, a specialist consultant gastroenterologist from Queen Elizabeth?s Hospital in Birmingham, said: ?In my opinion, Atorvastatin was the most likely cause of his liver failure, because of the recent commencement of the drug.? Dr Alan Taylor, a consultant cardiologist from North Devon District Hospital, performed the coronary angiogram on Mr Meacher in April 2004, which revealed his heart disease. Dr Taylor said recent evidence showed cholesterol levels in patients who took statin-type drugs were lowered 25-30% more than by diet alone. Fatal liver failure would only occur in one in ten million prescriptions. Dr John Christie, a consultant physician at the Royal Devon and Exeter Hospital, said because Mr Meacher had only just started taking the statin drug, it could be considered as a possible cause of his liver failure. However, the other likely explanation was an unexplained virus, said Dr Christie ? second commonest cause of liver failure after paracetamol overdose. ?We believe it to be a virus there is no test for. It?s commonly seen in larger liver units ? in a hospital such as ours, we see one or two cases a year. ?I think we can never know for certain whether Mr Meacher?s hepatitis was caused by the drug ? although the timing suggests it may have been,? he said. A post-mortem examination revealed Mr Meacher had died on August 11 from liver failure of unknown cause. Summing up, Dr Earland accepted Artorvastatin could lower cholesterol and reduce the risk of death by coronary heart disease. Research papers and medical evidence indicated there could have been an unidentified cause of Mr Meacher?s liver failure, but there was no evidence to prove this. Dr Earland said: ?I am persuaded by the temporal relationship of the prescription of Atorvastatin and his illness, that on the balance of probability, his death was due to the statin. Accordingly, my verdict on balance is misadventure.? Dr Earland said she would be writing to the Medicines and Healthcare Regulatory Agency to make sure that Atorvastatin was monitored closely and that changes in liver condition of patients on the drug be noted in the future. After the inquest, Jay Ballard, Mr Meacher?s daughter who lives near Liskeard, said her father, a former tennis coach, had been transformed from a very fit man who did not even realise he had a heart condition, to a very sick man in just weeks. She said the verdict was ?very fair?. ?The fact she is going to write to the MHRA I agree with ? it?s the best verdict I could have expected,? said Ms Ballard.