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Statin Therapy in Cirrhosis Patients

Authors

Tim Casey

San Diego—A retrospective database analysis of patients with cirrhosis found that statin therapy contributed to reduced liver disease progression and lower all-cause mortality rates.

Sonal Kumar, MD, the lead author of the study and a gastroenterology fellow at Brigham and Women’s Hospital in Boston, Massachusetts, presented the results at DDW during a news conference and plenary session.

Dr. Kumar said there is an increased prevalence of cardiovascular disease in patients with cirrhosis. Whereas the majority of those with cardiovascular disease take statins to lower their cholesterol and decrease the risk of heart attacks, statins cause concern for people with cirrhosis because they are metabolized by the liver. Some healthcare professionals believe that statins could contribute to severe liver failure in patients who have end stage liver disease or cirrhosis, according to Dr. Kumar.

Recent studies have shown statins are safe in patients with liver disease or cirrhosis. Dr. Kumar said she and her colleagues wanted to evaluate those findings further after one of her patients, who had not been prescribed statins because he had cirrhosis, died of a heart attack.

They used the Partners HealthCare Research Patient Data Registry of patients from 3 hospitals in Boston: Brigham and Women’s, Massachusetts General, and Faulkner Hospital. Inclusion criteria included patients ≥18 years of age, biopsy-proven cirrhosis, and statin therapy at biopsy and for 3 months after biopsy.

After the researchers selected 81 patients with cirrhosis who had taken statins, they chose 162 patients with the same severity of liver disease who did not receive statins. In their analysis, the researchers controlled for other factors such as the medications patients took and the presence of coronary artery disease, malignancies or diabetes.

The baseline characteristics were similar between the groups. Approximately 55% of patients were males; 70.4% of patients in each group were classified as Child-Pugh class A liver disease severity and 29.6% had Child-Pugh class B or C.

The median follow-up was 36 months in the statin group and 30 months in the control group. Patients took statins for a median of 25 months.

In the statin group, 38.2% of patients had liver decompensation compared with 50.6% of patients in the control group (P=.018). In addition, 2.5% of patients in the statin group and 17.9% of patients in the control group underwent liver transplants during treatment.

Overall mortality was 37.0% in the statin group and 50.6% in the control group (P=.043), and a multivariate analysis found statin use was significantly associated with lower mortality (odds ratio, 0.36; P=.007).

Dr. Kumar said the database did not provide a cause of death for approximately one third of patients, so the researchers could not determine if the mortality differed based on different causes.

The researchers mentioned a few study limitations, including the retrospective design, heterogeneous patient population with varied duration of statin therapy, and reporting bias. They also said the database did not adequately document compliance to statins, nor did it account for obesity, aspirin, or other nonsteroidal anti-inflammatory use, or active alcohol use. 

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