Cardiovascular disease is the leading cause of mortality in the United States. In high-risk patients, statin therapy has become the standard of care. In fact, statins are the most efficacious drugs for decreasing low-density lipoprotein cholesterol levels; they reduce both primary and secondary cardiovascular risk in the general population. However, less is known about the safety of statin use in patients with liver disease. Results from studies of statin therapy in patients with elevated liver enzyme levels, nonalcoholic fatty liver disease, hepatitis C, cirrhosis, liver transplants, and hepatocellular carcinoma show benefit without increased risk of adverse effects. Thus, based on available evidence, statin therapy should not be withheld in this patient population; however, more robust, prospective clinical trials are needed to confirm the safety and efficacy.