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Statins in Compensated and Decompensated Cirrhosis: Approaching the Bedside

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Portal Hypertension VII

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Abstract

Chronic liver injuries evolve from benign and manageable dysfunction to life-threatening end-stage liver disease with severe complications especially due to portal hypertension. Still liver transplantation remains the only and final curative option for end-stage liver disease, while several drugs have been repurposed for the treatment of complications of cirrhosis in this setting. The demand for organ transplants exceeds by far the supply and therefore those treatment options are urgently needed. But the evidence is not always as encouraging and of high enough good quality.

One example is statins, primarily cholesterol-lowering drugs, but broadly used for primary or secondary prevention of cardiovascular diseases. The beneficial effects of statins are mediated by the so-called pleiotropic mechanisms on inflammation, fibrosis, endothelial function, thrombosis, coagulation, and contraction of contractile cells to improve portal hypertension. However, concerns remain about the efficacy and safety of some statins due to their potential hepatotoxic risks and as of now, these risks impede broader use of statins in the treatment of chronic liver diseases.

This chapter tries to comprehensively describe the mechanisms by which statins may improve pathophysiological processes and summarize the clinical experience of statin use in the treatment of liver cirrhosis.

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Abbreviations

BDL:

Bile duct ligation

CRP:

C-reactive protein

CVD:

Cardiovascular disease

ECM:

Extracellular matrix

eNOS:

Endothelial nitric oxide synthase

FPP:

Farnesyl-pyrophosphate

GGPP:

Geranylgeranyl-pyrophosphate

HCC:

Hepatocarcinoma

HCV:

Viral hepatitis C

HMG-CoA:

3-Hydroxy-3-methyl-glutaryl-coenzyme A

HSC:

Hepatic stellate cell

KLF2:

Kruppel-like factor 2

MS:

Metabolic syndrome

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic steatohepatitis

NOX2:

Nicotinamide adenine dinucleotide phosphate oxidase isoform 2

PNPLA3:

Patatin-like phospholipase domain-containing protein 3

PPARα:

Activated peroxisome proliferator-activated receptor alpha

SREBP:

Sterol regulatory element binding proteins

UDCA:

Ursodeoxycholic acid

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Authors and Affiliations

  1. Department of Internal Medicine B, University of Münster, Münster, Germany

    Jonel Trebicka

  2. European Foundation for the Study of Chronic Liver Failure—EF Clif, Barcelona, Spain

    Jonel Trebicka

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  1. Jonel Trebicka
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Correspondence to Jonel Trebicka .

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  1. Gastroenterology Unit, University of Milan, Milan, Milano, Italy

    Roberto de Franchis

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Trebicka, J. (2022). Statins in Compensated and Decompensated Cirrhosis: Approaching the Bedside. In: de Franchis, R. (eds) Portal Hypertension VII. Springer, Cham. https://doi.org/10.1007/978-3-031-08552-9_23

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  • DOI: https://doi.org/10.1007/978-3-031-08552-9_23

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