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Statins linked to lower risk for cirrhosis in chronic liver diseases

Results of a systematic review and meta-analysis showed a probable association between statin use and a lower risk for hepatic decompensation and mortality in patients with chronic liver disease. Further, statin use may reduce portal hypertension in these patients.

“Statins are one class of medications being studied to determine their effect on progression and decompensation of [chronic liver diseases],” Rebecca G. Kim, MD, MS, from the University of California at San Diego, and colleagues wrote. “Epidemiological studies have observed a protective association between statin use and hepatocellular cancer. Recent studies have also suggested an association between statin use and risk of fibrosis progression and hepatic decompensation in patients with [chronic liver diseases], although the effects have been variable.”

To determine the association between statin use and the risk for fibrosis progression or cirrhosis development, risk for developing decompensated cirrhosis, mortality and progression of portal hypertension, researchers reviewed the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database and Systematic Reviews, Scopus, Web of Science and PubMed databases.

Thirteen studies totaling 121,058 patients initially met the researchers’ criteria, including three randomized control trials and 10 observational studies. Two studies were later excluded due to similar population and insufficient information, respectively.

Five studies reported statin use was associated with a 58% lower risk for development of cirrhosis or progression of fibrosis in patients with non-cirrhotic chronic liver diseases (RR = 0.42; 95% CI, 0.16-1.11). Excluding one of these studies that relied solely on administrative claims codes, the researchers found a 35% lower risk (RR = 0.65; 95% CI, 0.48-0.87). Three of these studies reported specifically on the risk for fibrosis progression, resulting in a 27% lower risk (RR = 0.73; 95% CI, 0.54-1).

Four studies reported a 46% lower risk for progression to decompensated cirrhosis in both patients with baseline compensated cirrhosis and non-cirrhotic chronic liver diseases (RR = 0.54; 95% CI, 0.46-0.62). In patients with baseline compensation only, there was a similar protective association between statin use and risk for hepatic decompensation (RR = 0.54; 95% CI, 0.44-0.66).

Six studies reported statin use was associated with a 39% lower risk for mortality (RR = 0.61; 95% CI, 0.48-0.78). Out of four studies that reported on the risk for re-bleeding or clinically significant improvement in portal hypertension in patients with baseline cirrhosis, three randomized control trials reported a 27% lower risk (RR = 0.73; 95% CI, 0.59-0.91) and one observational study reported a 61% lower risk (RR = 0.39; 95% CI, 0.19-0.79).

“Moderate quality evidence suggests beneficial effect of statins on risk of hepatic decompensation and mortality, and variceal bleeding, especially in patients with known compensated cirrhosis, and low quality evidence suggests a mortality benefit in patients with [chronic liver diseases],” the researchers concluded. “Large, pragmatic [randomized control trials] in patients with compensated cirrhosis, are required to confirm these observations.” – by Talitha Bennett

Disclosures: The researchers report no relevant financial disclosures.