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Statin use in HCV patients may lower risk of death, decompensation

VIENNA — Statin use in patients with hepatitis C virus and compensated cirrhosis seems to offer a protective effect against death and decompensation, according to a study presented at the 2015 International Liver Congress.

“In compensated HCV cirrhosis, statin users have a significantly lower incidence of decompensation and better overall survival compared to statin non-users,” Arpan Mohanty, MD, from Yale School of Medicine, New Haven, Conn., said during her presentation. “Risk of decompensation and death was reduced by over 40%.”

In this retrospective cohort study, Mohanty and colleagues used the U.S. Department of Veterans HCV Clinical Case Registry, and by doing so, she said all patients would have had an equal opportunity to receive statins.

To mimic a randomized controlled trial, propensity score matching was used to take the 43,350 patients who were monoinfected with HCV and had cirrhosis down to down to 2,062 non-users and 685 users matched by their likelihood of receiving statins. These patients were then matched 5:1, using the five non-users’ averages to represent one non-user. The matched cohorts were similar at baseline in age, race, sex, lab results and comorbidities.

“The probability of decompensation and death were significantly lower in the statin users,” Mohanty said (P < .001 for both).

Unadjusted hazard ratios for decompensation and death were significantly lower in the statin group with an HR of 0.55 for decompensation (0.39-0.77) and 0.56 for death (0.46-0.69).

“When adjusted for common predictors of decompensation and death in compensated cirrhosis, like age, BMI, albumin, [fibrosis 4] and MELD [score], the risk of decompensation in statin use was reduced by 45% and that, too, of death,” Mohanty said.

Sensitivity analyses considering an alternate definition of decompensation, excluding patients without HCV-RNA confirmation and excluding patients who received HCV antiviral therapy also yielded similar hazards ratios.

“Statin use is low in patients with cirrhosis, even in those with a high cardiovascular risk,” Mohanty said. “Until randomized controlled trials confirm these results, statins cannot be widely recommended in this setting. However, in patients who otherwise require statins, their use should not be avoided.” – by Katrina Altersitz

For More Information:

Mohanty A. Abstract O072. Presented at: International Liver Congress; April 22-26, 2015; Vienna.

Disclosure: Mohanty reports no relevant financial relationships.