June 23, 2017
By Marilynn Larkin
NEW YORK (Reuters Health) - Statins may slow the progression of hepatic fibrosis, prevent cirrhosis-related hepatic decompensation and reduce all-cause mortality in patients with chronic liver disease - but the evidence is low, researchers say.
“Our meta-analysis was largely based on observational studies and only one randomized trial was included,” Dr. Muhammad Ali Khan of the University of Tennessee Health Science Center in Memphis told Reuters Health.
Despite the low evidence, the study supports the role of statins in chronic liver disease, he said by email, “contrary to the commonly held belief among physicians that statins should be avoided . . . due to fear of worsening liver functions.”
“We did not find any evidence that statins are deleterious in (these) patients,” he added.
Dr. Khan and colleagues searched various databases from inception to October 2016 to identify comparative studies evaluating the effects of statins on chronic liver disease. Ten studies with close to 260,000 patients (about 54,000 statin users) were included in their analyses.
As reported in the American Journal of Gastroenterology, online June 6, the pooled hazard ratio for the association of statin use with progression of hepatic fibrosis was 0.49 overall.
However, given the heterogeneity in methods of estimating fibrosis progression, the team performed a subgroup analysis based on the method used to detect progression and the subsequent development of cirrhosis.
Studies that used International Classification of Diseases, Ninth Revision (ICD-9) coding and a secondary method such as the Ishak score, FIB-4 (Fibrosis-4) score, or the APRI score (aspartate aminotransferase to platelet ratio index) were grouped separately from studies that relied on ICD-9 coding alone or did not mention the detection method.
The pooled HR was 0.58 for studies using ICD-9 coding and a second method to detect cirrhosis, and 0.36 for studies using ICD-9 coding alone.
Since hepatitis C virus (HCV) infection is one of the most common causes of chronic liver disease in the U.S., the researchers conducted a separate sensitivity analysis focusing on patients with HCV as the underlying cause. Statins still showed a significant reduction in the progression of hepatic fibrosis, with a pooled HR of 0.52.
“Most importantly, we noted a beneficial effect of statins on overall survival in patients with cirrhosis,” the authors observed. The pooled HR for mortality based on observational studies was 0.67, and 0.39 in the randomized controlled trial. In addition, the pooled HR for hepatic decompensation was 0.54.
The authors could not evaluate the effects of individual statins or the duration of statin therapy on any of the endpoints since the data were not uniformly reported.
Dr. Khan said, “Based on our results, if patients are taking statins for valid medical indications, they should be continued even in presence of liver disease, as (the statins) may help in retarding progression of chronic liver disease.”
“However, due to the low quality of evidence, they cannot be routinely recommended at this time solely for prevention against liver disease,” he concluded.
Hepatologist Dr. Hillel Tobias of the NYU Langone Medical Center in New York City told Reuters Health he was “very impressed” by the study.
“Statins have been underappreciated in many subspecialties in medicine, especially in the liver field,” he said by email. “In the past, many primary care physicians always associated statins with abnormal liver enzymes causing liver injury. There is really no basis for it. Any medication that a patient takes can cause liver injury but it is incredibly rare with a statin.”
“In our own clinical practice, we are currently prescribing statins to people with nonalcoholic fatty liver disease on the basis of the studies that have been published in the last two to three years,” he noted.
“This study substantiates several other studies that have been published in much smaller medical publications,” he added. “Liver specialists know this information, but I think we need to go out and educate the rest of the medical community.”
Am J Gastroenterol 2017.
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