Skip to main content

Abstract

A broad group of physicians is still afraid of administering statins because of the myth of statin toxicity and frequent statin-related nocebo effects. However, due to the statins cholesterol independent mechanism of action -pleiotropic effects, the focus on these drugs has shifted from harmful to helpful in patients with chronic liver disease. Recently, and most likely through these mentioned effects, statins were associated with significant clinical outcomes in these patients. Although only through experimental trials, this chapter describes the efficacy of statins in matter topics of Hepatology as portal hypertension, decompensated cirrhosis, and hepatocellular carcinoma. Finally, there is a discussion regarding the safety of statins in decompensated cirrhosis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Steinberg D, Gotto AM Jr. Preventing coronary artery disease by lowering cholesterol levels: fifty years from bench to bedside. JAMA. 1999;82:2043–50.

    Google Scholar 

  2. Dawber TR, Kannel WB, Revotskie N, et al. Some factors associated with the development of coronary heart disease. Six years’ follow-up experience in the Framingham study. Am J Public Health Nations Health. 1959;49:1349–56.

    Google Scholar 

  3. Tobert JA. Lovastatin and beyond: the history of the HMG-COA reductase inhibitors. Nat Rev Drug Discov. 2003;2:517–26.

    Google Scholar 

  4. Kirby TJ. Cataracts produced by triparanol. Trans Am Ophthalmol Soc. 1967;65:494–543.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Endo A, Kuroda M, Tsujita Y. ML-236A, ML-236B, and ML-236C, new inhibitors of cholesterogenesis produced by penicillium citrinium. J Antibiot. 1976;29:1346–8.

    Google Scholar 

  6. Endo A, Kuroda M, Tanzawa K. Competitive inhibition of 3-hydroxy-3-methylglutaryl coenzyme a reductase by ML-236a and ML-236b fungal metabolites, having hypocholesterolemic activity. FEBS Lett. 1976;72:323–6.

    Google Scholar 

  7. Endo A, Tsujita Y, Kuroda M, et al. Inhibition of cholesterol synthesis in vitro and in vivo by ML-236A and ML-236B, competitive inhibitors of 3-hydroxy-3methylglutaryl-coenzyme a reductase. Eur J Biochem. 1977;77:31–6.

    Google Scholar 

  8. Alberts AW, Chen J, Kuron G, Hunt V, et al. Mevinolin: a highly potent competitive inhibitor of hydroxymethylglutaryl-coenzyme a reductase and a cholesterol-lowering agent. Proc Natl Acad Sci U S A. 1980;77:3957–61.

    Google Scholar 

  9. Bilheimer DW, Grundy SM, Brown MS, et al. Mevinolin and colestipol stimulate receptor-mediated clearance of low density lipoprotein from plasma in familial hypercholesterolemia heterozygotes. Proc Natl Acad Sci U S A. 1983;80:4124–8.

    Google Scholar 

  10. Illingworth DR, Sexton GJ. Hypocholesterolemic effects of mevinolin in patients with heterozygous familial hypercholesterolemia. J Clin Invest. 1984;74:1972–8.

    Google Scholar 

  11. Lovastatin Study Group II. Therapeutic response to lovastatin (mevinolin) in nonfamilial hypercholesterolemia. A multicenter study. JAMA. 1986;256:2829–34.

    Google Scholar 

  12. Lovastatin Study Group III. A multicenter comparison of lovastatin and cholestyramine therapy for severe primary hypercholesterolemia. JAMA. 1989;260:359–66.

    Google Scholar 

  13. Lovastatin Study Group IV. A multicenter comparison of lovastatin and probucol for the treatment of severe primary hypercholesterolemia. Am J Cardiol. 1990;66:22B–30B.

    Google Scholar 

  14. Tobert JA, Shear CL, Chremos AN, et al. Clinical experience with lovastatin. Am J Cardiol. 1990;65:23F–6F.

    Google Scholar 

  15. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian simvastatin survival study (4S). Lancet. 1994;344:1383–9.

    Google Scholar 

  16. Bolego C, Baetta R, Bellosta S, et al. Safety considerations for statins. Curr Opin Lipidol. 2002;13:637–44.

    Google Scholar 

  17. Ballantyne CM, Corsini A, Davidson MH, et al. Risk for myopathy with statin therapy in high-risk patients. Arch Intern Med. 2003;163:553–64.

    Google Scholar 

  18. Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20.536 high-risk individuals: a randomized placebo-controlled trial. Lancet. 2002;360:7–22.

    Google Scholar 

  19. Bosch J. Vascular deterioration in cirrhosis. The big picture. J Clin Gastroenterol. 2007;41:S247–53.

    Google Scholar 

  20. Bhathal PS, Grossman HJ. Reduction of the increased portal vascular resistance of the isolated perfused cirrhotic rat liver by vasodilators. J Hepatol. 1985;1:325–37.

    Google Scholar 

  21. Marteau P, Ballet F, Chazouilleres O, et al. Effect of vasodilators on hepatic microcirculation in cirrhosis: a study in the isolated perfused rat liver. Hepatology. 1989;9:820–3.

    Google Scholar 

  22. Bosch J, Abraldes JG, Groszmann RJ. Current management of portal hypertension. J Hepatol. 2003;38:S54–68.

    Google Scholar 

  23. Gupta TK, Toruner M, Chung MK, et al. Endothelial dysfunction and decreased production of nitric oxide in the intrahepatic microcirculation of cirrhotic rats. Hepatology. 1998;28:926–31.

    Google Scholar 

  24. Rockey DC, Chung JJ. Reduced nitric oxide production by endothelial cells in cirrhotic rat liver: endothelial dysfunction in portal hypertension. Gastroenterology. 1998;114:344–51.

    Google Scholar 

  25. Shah V, Toruner M, Haddad F, et al. Impaired endothelial nitric oxide synthase activity associated with enhanced caveolin binding in experimental cirrhosis in the rat. Gastroenterology. 1999;117:1222–8.

    Google Scholar 

  26. Shah V, Cao S, Hendrickson H, et al. Regulation of hepatic eNOS by caveolin and calmodulin after bile duct ligation in rats. Am J Physiol Gastrointest Liver Physiol. 2001;280:G1209–16.

    Google Scholar 

  27. Bellis L, Berzigotti A, Abraldes JG, et al. Low doses of isosorbide mononitrate attenuate the postprandial increase in portal pressure in patients with cirrhosis. Hepatology. 2003;37:378–84.

    Google Scholar 

  28. Ceriello A, Taboga C, Tonutti L, et al. Evidence for an independent and cumulative effect of postprandial hypertriglyceridemia and hyperglycemia on endothelial dysfunction and oxidative stress generation: effects of short- and long-term simvastatin treatment. Circulation. 2002;106:1211–8.

    Google Scholar 

  29. Van de Casteele M, Omasta A, Janssens S, et al. In vivo gene transfer of endothelial nitric oxide synthase decreases portal pressure in anaesthetised carbon tetrachloride cirrhotic rats. Gut. 2002;51:440–5.

    Google Scholar 

  30. Sarela AI, Mihaimeed FM, Batten JJ, et al. Hepatic and splanchnic nitric oxide activity in patients with cirrhosis. Gut. 1999;44:749–53.

    Google Scholar 

  31. Shah V. Cellular and molecular basis of portal hypertension. Clin Liver Dis. 2001;5:629–44.

    Google Scholar 

  32. Wiest R, Groszmann RJ. The paradox of nitric oxide in cirrhosis and portal hypertension: too much, not enough. Hepatology. 2002;35:478–91.

    Google Scholar 

  33. Russell R. Atherosclerosis - an inflammatory disease. N Engl J Med. 1999;340:115–26.

    Google Scholar 

  34. Goldstein JL, Brown MS. Regulation of the mevalonate pathway. Nature. 1990;343:425–30.

    Google Scholar 

  35. Van Aelst L, D’Souza-Schorey C. Rho GTPases and signaling networks. Genes Dev. 1997;11:2295–322.

    Google Scholar 

  36. Hall A. Rho GTPases and the actin cytoskeleton. Science. 1998;279:509–14.

    Google Scholar 

  37. Shimizu T, Liao JK. Rho kinases and cardiac remodeling. Circ J. 2016;80:1491–8.

    Google Scholar 

  38. Wolfrum S, Jensen KS, Liao JK. Endothelium-dependent effects of statins. Arterioscler Thromb Vasc Biol. 2003;23:729–36.

    Google Scholar 

  39. Oesterle A, Laufs U, Liao JK. Pleiotropic effects of statins on the cardiovascular system. Circ Res. 2017;120:229–43.

    Google Scholar 

  40. Steinberg D, Parthasarathy S, Carew TE, et al. Beyond cholesterol. Modifications of low-density lipoprotein that increase its atherogenicity. N Engl J Med. 1989;320:915–24.

    Google Scholar 

  41. Harrison DG. Perspective series: nitric oxide and nitric oxide synthases cellular and molecular. Mechanisms of endothelial cell dysfunction. J Clin Invest. 1997;100:2153–7.

    Google Scholar 

  42. Liao JK. Inhibition of Gi proteins by low density lipoprotein attenuates bradykinin-stimulated release of endothelial-derived nitric oxide. J Biol Chem. 1994;269:12987–92.

    Article  CAS  Google Scholar 

  43. Alderson LM, Endemann G, Lindsey S, et al. LDL enhances monocyte adhesion to endothelial cells in vitro. Am J Pathol. 1986;123:334–42.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Plenz GAM, Oliver Hofnagel O, Robenek H. Differential modulation of caveolin-1 expression in cells of the vasculature by statins. Circulation. 2004;109:e7–8.

    Google Scholar 

  45. Kureishi Y, Luo Z, Shiojima I, Bialik A, et al. The HMG-CoA reductase inhibitor simvastatin activates the protein kinase Akt and promotes angiogenesis in normocholesterolemic animals. Nat Med. 2000;6:1004–10.

    Google Scholar 

  46. Dimmeler S, Fleming I, Fisslthaler B, et al. Activation of nitric oxide synthase in endothelial cells by Akt-dependent phosphorylation. Nature. 1999;399:601–5.

    Google Scholar 

  47. Wolfrum S, Dendorfer A, Rikitake Y, et al. Inhibition of rho-kinase leads to rapid activation of phosphatidylinositol 3-kinase/protein kinase Akt and cardiovascular protection. Arterioscler Thromb Vasc Biol. 2004;24:1842–7.

    Google Scholar 

  48. Laufs U, Liao JK. Post-transcriptional regulation of endothelial nitric oxide synthase mRNA stability by rho GTPase. J Biol Chem. 1998;273:24266–71.

    Google Scholar 

  49. Sen-Banerjee S, Mir S, Lin Z, et al. Kruppel-like factor 2 as a novel mediator of statin effects in endothelial cells. Circulation. 2005;112:720–6.

    Google Scholar 

  50. Martin JE, Cavanaugh TM, Trumbull L, et al. Incidence of adverse events with HMG-CoA reductase inhibitors in liver transplant patients. Clin Transpl. 2008;22:113–9.

    Google Scholar 

  51. Trebicka J, Hennenberg M, Laleman W, et al. Atorvastatin lowers portal pressure in cirrhotic rats by inhibition of RhoA/Rho-kinase and activation of endothelial nitric oxide synthase. Hepatology. 2007;46:242–53.

    Google Scholar 

  52. Trebicka J, Hennenberg M, Odenthal M, et al. Atorvastatin attenuates hepatic fibrosis in rats after bile duct ligation via decreased turnover of hepatic stellate cells. J Hepatol. 2010;53:702–12.

    Google Scholar 

  53. Klein S, Klosel J, Schierwagen R, et al. Atorvastatin inhibits proliferation and apoptosis, but induces senescence in hepatic myofibroblasts and thereby attenuates hepatic fibrosis in rats. Lab Investig. 2012;92:1440–50.

    Google Scholar 

  54. Abraldes JG, Rodriguez-Vilarrupla A, Graupera M, et al. Simvastatin treatment improves liver sinusoidal endothelial dysfunction in CCl4 cirrhotic rats. J Hepatol. 2007;46:1040–6.

    Google Scholar 

  55. Marrone G, Russo L, Rosado E, et al. The transcription factor KLF2 mediates hepatic endothelial protection and paracrine endothelial-stellate cell deactivation induced by statins. J Hepatol. 2013;58:98–103.

    Google Scholar 

  56. Marrone G, Maeso-Diaz R, Garcia-Cardena G, et al. KLF2 exerts antifibrotic and vasoprotective effects in cirrhotic rat livers: behind the molecular mechanisms of statins. Gut. 2015;64:1434–43.

    Google Scholar 

  57. Schierwagen R, Maybüchen L, Hittatiya K, et al. Statins improve NASH via inhibition of RhoA and Ras. Am J Physiol Gastrointest Liver Physiol. 2016;311:G724–33.

    Google Scholar 

  58. Jain MK, Ridker PM. Anti-inflammatory effects of statins: clinical evidence and basic mechanisms. Nat Rev Drug Discov. 2005;4:977–87.

    Google Scholar 

  59. La Mura V, Pasarin M, Meireles CZ, et al. Effects of simvastatin administration on rodents with lipopolysaccharide-induced liver microvascular dysfunction. Hepatology. 2013;57:1172–81.

    Google Scholar 

  60. Wagner AH, Schwabe O, Hecker M. Atorvastatin inhibition of cytokine inducible nitric oxide synthase expression in native endothelial cells in situ. Br J Pharmacol. 2002;136:143–9.

    Google Scholar 

  61. Huang KC, Chen CW, Chen JC, et al. HMG-CoA reductase inhibitors inhibit inducible nitric oxide synthase gene expression in macrophages. J Biomed Sci. 2003;10:396–405.

    Google Scholar 

  62. Relja B, Meder F, Wang M, et al. Simvastatin modulates the adhesion and growth of hepatocellular carcinoma cells via decrease of integrin expression and ROCK. Int J Oncol. 2011;38:879–85.

    Google Scholar 

  63. Zafra C, Abraldes JG, Turnes J, et al. Simvastatin enhances hepatic nitric oxide production and decreases the hepatic vascular tone in patients with cirrhosis. Gastroenterology. 2004;126:749–55.

    Google Scholar 

  64. Abraldes JG, Albillos A, Bañares R, et al. Simvastatin lowers portal pressure in patients with cirrhosis and portal hypertension: a randomized controlled trial. Gastroenterology. 2009;136:1651–8.

    Google Scholar 

  65. Motzkus-Feagans C, Pakyz AL, Ratliff SM, et al. Statin use and infections in veterans with cirrhosis. Aliment Pharmacol Ther. 2013;38:611–8.

    Google Scholar 

  66. Kumar S, Grace ND, Qamar AA. Statin use in patients with cirrhosis: a retrospective cohort study. Dig Dis Sci. 2014;59:1958–65.

    Google Scholar 

  67. Simon TG, King LY, Zheng H, et al. Statin use is associated with a reduced risk of fibrosis progression in chronic hepatitis C. J Hepatol. 2015;62:18–23.

    Google Scholar 

  68. Yang YH, Chen WC, Tsan YT, et al. Statin use and the risk of cirrhosis development in patients with hepatitis C virus infection. J Hepatol. 2015;63:1111–7.

    Google Scholar 

  69. Hsiang JC, Wong GLH, Tse YK, et al. Statin and the risk of hepatocellular carcinoma and death in a hospital-based hepatitis B-infected population: a propensity score landmark analysis. J Hepatol. 2015;63:1190–7.

    Google Scholar 

  70. Mohanty A, Tate JP, Garcia-Tsao G. Statins are associated with a decreased risk of decompensation and death in veterans with hepatitis C-related compensated cirrhosis. Gastroenterology. 2016;150:430–40.e1.

    Google Scholar 

  71. Bang UC, Benfield T, Bendtsen F. Reduced risk of decompensation and death associated with use of statins in patients with alcoholic cirrhosis. A nationwide case-cohort study. Aliment Pharmacol Ther. 2017;46:673–80.

    Google Scholar 

  72. Chang FM, Wang YP, Lang HC, et al. Statins decrease the risk of decompensation in hepatitis B virus- and hepatitis C virus-related cirrhosis: a population-based study. Hepatology. 2017;66:896–907.

    Google Scholar 

  73. Kim G, Jang SY, Nam CM, et al. Statin use and the risk of hepatocellular carcinoma in patients at high risk: a nationwide nested case-control study. J Hepatol. 2018;68:476–84.

    Google Scholar 

  74. Kaplan DE, Serper MA, Mehta R, et al. Effects of hypercholesterolemia and statin exposure on survival in a large national cohort of patients with cirrhosis. Gastroenterology. 2019;156:1693–1706.e12.

    Google Scholar 

  75. Sano M, Bell KL, Galasko D, et al. A randomized, double-blind, placebo-controlled trial of simvastatin to treat Alzheimer disease. Neurology. 2011;77:556–63.

    Google Scholar 

  76. Papazian L, Roch A, Charles PE, et al. Effect of statin therapy on mortality in patients with ventilator associated pneumonia: a randomized clinical trial. JAMA. 2013;310:1692–700.

    Google Scholar 

  77. McAuley DF, Laffey JG, O’Kane CM, et al. Simvastatin in the acute respiratory distress syndrome. N Engl J Med. 2014;371:1695–703.

    Google Scholar 

  78. Kamm CP, El-Koussy M, Humpert S, et al. Atorvastatin added to interferon beta for relapsing multiple sclerosis: 12-month treatment extension of the randomized multicenter SWABIMS trial. PLoS One. 2014;9:e86663.

    Google Scholar 

  79. Kim ST, Kang JH, Lee J, et al. Simvastatin plus capecitabine-cisplatin versus placebo plus capecitabine cisplatin in patients with previously untreated advanced gastric cancer: a double-blind randomised phase 3 study. Eur J Cancer. 2014;50:2822–30.

    Google Scholar 

  80. Dhamija P, Hota D, Kochhar R, et al. Randomized clinical trial: atorvastatin versus placebo in patients with acute exacerbation of mild to moderate ulcerative colitis. Indian J Gastroenterol. 2014;33:151–6.

    Google Scholar 

  81. John ME, Cockcroft JR, McKeever TM, et al. Cardiovascular and inflammatory effects of simvastatin therapy in patients with COPD: a randomized controlled trial. Int J Chron Obstruct Pulm Dis. 2015;10:211–21.

    Google Scholar 

  82. Garcia-Pagan JC, Groszmann RJ, Bosch J. Portal hypertension. In: Weinstein WM, Hawkey CJ, Bosch J, editors. Clinical gastroenterology and hepatology, vol. 2005. Philadelphia: Elsevier Mosby; 2005. p. 707–16.

    Google Scholar 

  83. Berzigotti A, Seijo S, Reverter E, et al. Assessing portal hypertension in liver diseases. Rev Gastroenterol Hepatol. 2013;7:141–55.

    Google Scholar 

  84. Ripoll C, Groszmann R, Garcia-Tsao G, et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. 2007;133:481–8.

    Google Scholar 

  85. Cadelina G, Shah V, Choo K, et al. Elevated portal pressure in mice with targeted disruption of the gene for endothelial nitric oxide synthase. Hepatology. 2002;32:A12.

    Google Scholar 

  86. Abraldes JG, Villanueva C, Aracil C, et al. Addition of simvastatin to standard therapy for the prevention of variceal rebleeding does not reduce rebleeding but increases survival in patients with cirrhosis. Gastroenterology. 2016;150:1160–70.e3.

    Google Scholar 

  87. Pollo-Flores P, Soldan M, Santos U, et al. Three months of simvastatin therapy vs. placebo for severe portal hypertension in cirrhosis: a randomized controlled trial. Dig Liver Dis. 2015;47:957–63.

    Google Scholar 

  88. Bishnu S, Ahammed SM, Sarkar A, et al. Effects of atorvastatin on portal hemodynamics and clinical outcomes in patients with cirrhosis with portal hypertension: a proof of concept study. Eur J Gastroenterol Hepatol. 2018;30:54–9.

    Google Scholar 

  89. Wani ZA, Mohapatra S, Khan AA. Addition of simvastatin to carvedilol non responders: a new pharmacological therapy for treatment of portal hypertension. World J Hepatol. 2017;9:270–7.

    Google Scholar 

  90. Vijayaraghavan R, Jindal A, Arora V, et al. Hemodynamic effects of adding simvastatin to carvedilol for primary prophylaxis of variceal bleeding: a randomized controlled trial. Am J Gastroenterol. 2020;115:729–37.

    Google Scholar 

  91. Elwan N, Salah R, Hamisa M, et al. Evaluation of portal pressure by doppler ultrasound in patients with cirrhosis before and after simvastatin administration - a randomized controlled trial. F1000Res. 2018;7:256.

    Google Scholar 

  92. D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–31.

    Google Scholar 

  93. Caraceni P, Abraldes JG, Gines P, et al. The search for disease-modifying agents in decompensated cirrhosis: from drug repurposing to drug discovery. J Hepatol. 2021;75:S118–34.

    Google Scholar 

  94. Bernardi M, Moreau R, Angeli P, et al. Mechanisms of decompensation and organ failure in cirrhosis: from peripheral arterial vasodilation to systemic inflammation hypothesis. J Hepatol. 2015;63:1272–84.

    Google Scholar 

  95. Wiest R, Lawson M, Geuking M. Pathological bacterial translocation in liver cirrhosis. J Hepatol. 2014;60:197–209.

    Google Scholar 

  96. Bernardi M, Caraceni P. Novel perspectives in the management of decompensated cirrhosis. Nat Rev Gastroenterol Hepatol. 2018;15:753–64.

    Google Scholar 

  97. Thompson PD, Panza G, Zaleski A, et al. Statin-associated side effects. J Am Coll Cardiol. 2016;67:2395–410.

    Google Scholar 

  98. Malizia G, D'Amico G. Statins in cirrhosis: the magic pill? Hepatology. 2016;63:2047–9.

    Google Scholar 

  99. Muñoz AE, Taddey W, Salgado P. Addition of simvastatin to the standard therapy increases survival and is safe in patients with decompensated cirrhosis. Gastroenterol Hepatol. 2019;4:1–5.

    Google Scholar 

  100. Muñoz AE, Pollarsky F, Marino M, et al. Further analysis of simvastatin safety trial in patients with decompensated cirrhosis provides promising information about improving liver function and reducing cirrhosis severity. J Hepatol. 2021;75:S346.

    Google Scholar 

  101. Baecker A, Liu X, La Vecchia C, et al. Worldwide incidence of hepatocellular carcinoma cases attributable to major risk factors. Eur J Cancer Prev. 2018;27:205–12.

    Google Scholar 

  102. Yang JD, Hainaut P, Gores GJ, et al. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol. 2019;16:589–604.

    Google Scholar 

  103. Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018;391:1301–14.

    Google Scholar 

  104. Saffo S, Taddei TH. Systemic management for advanced hepatocellular carcinoma: a review of the molecular pathways of carcinogenesis, current and emerging therapies, and novel treatment strategies. Dig Dis Sci. 2019;64:1016–29.

    Google Scholar 

  105. Villanueva A. Hepatocellular carcinoma. N Engl J Med. 2019;380:1450–62.

    Google Scholar 

  106. Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–90.

    Google Scholar 

  107. Cheng AL, Kang YK, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10:25–34.

    Google Scholar 

  108. Kim G, Kang ES. Prevention of hepatocellular carcinoma by statins: clinical evidence and plausible mechanisms. Semin Liver Dis. 2019;39:141–52.

    Google Scholar 

  109. Kubatka P, Kruzliak P, Rotrekl V, et al. Statins in oncological research: from experimental studies to clinical practice. Crit Rev Oncol Hematol. 2014;92:296–311.

    Google Scholar 

  110. Sutter AP, Maaser K, Hopfner M, et al. Cell cycle arrest and apoptosis induction in hepatocellular carcinoma cells by HMG-CoA reductase inhibitors. Synergistic antiproliferative action with ligands of the peripheral benzodiazepine receptor. J Hepatol. 2005;43:808–16.

    Google Scholar 

  111. Hijona E, Banales JM, Hijona L, et al. Pravastatin inhibits cell proliferation and increased MAT1A expression in hepatocarcinoma cells and in vivo models. Cancer Cell Int. 2012;12:5.

    Google Scholar 

  112. Riaño I, Martin L, Varela M, et al. Efficacy and safety of the combination of pravastatin and sorafenib for the treatment of advanced hepatocellular carcinoma (ESTAHEP clinical trial). Cancers (Basel). 2020;12:1900.

    Google Scholar 

  113. Blanc JF, Khemissa F, Bronowicki JP, et al. Phase 2 trial comparing sorafenib, pravastatin, their combination or supportive care in HCC with Child-Pugh B cirrhosis. Hepatol Int. 2021;15:93–104.

    Google Scholar 

  114. Jouve JL, Lecomte T, Bouché O, et al. Pravastatin combination with sorafenib does not improve survival in advanced hepatocellular carcinoma. J Hepatol. 2019;71:516–22.

    Google Scholar 

  115. Kawata S, Yamasaki E, Nagase T, et al. Effect of pravastatin on survival in patients with advanced hepatocellular carcinoma. A randomized controlled trial. Br J Cancer. 2001;84:886–91.

    Google Scholar 

  116. Graf H, Jungst C, Straub G, et al. Chemoembolization combined with pravastatin improves survival in patients with hepatocellular carcinoma. Digestion. 2008;78:34–8.

    Google Scholar 

  117. Bil J, Zapala L, Nowis D, et al. Statins potentiate cytostatic/cytotoxic activity of sorafenib but not sunitinib against tumor cell lines in vitro. Cancer Lett. 2010;288:57–67.

    Google Scholar 

  118. Tsan YT, Lee CH, Ho WC, et al. Statins and the risk of hepatocellular carcinoma in patients with hepatitis C virus infection. J Clin Oncol. 2013;31:1514–21.

    Google Scholar 

  119. Kamal S, Khan MA, Seth A, et al. Beneficial effects of statins on the rates of hepatic fibrosis, hepatic decompensation, and mortality in chronic liver disease: a systematic review and meta-analysis. Am J Gastroenterol. 2017;112:1495–505.

    Google Scholar 

  120. Bader T. The myth of statin-induced hepatotoxicity. Am J Gastroenterol. 2010;105:978–80.

    Google Scholar 

  121. Tolman KG. The liver and lovastatin. Am J Cardiol. 2002;89:1374–80.

    Google Scholar 

  122. Rzouq FS, Volk ML, Hatoum HH, et al. Hepatotoxicity fears contribute to underutilization of statin medications by primary care physicians. Am J Med Sci. 2010;340:89–93.

    Google Scholar 

  123. Lewis JH, Mortensen ME, Zweig S, et al. Efficacy and safety of high-dose pravastatin in hypercholesterolemic patients with well-compensated chronic liver disease: results of a prospective, randomized, double-blind, placebo-controlled, multicenter trial. Hepatology. 2007;46:1453–63.

    Google Scholar 

  124. Athyros VG, Tziomalos K, Gossios TD, et al. Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek atorvastatin and coronary heart disease evaluation (GREACE) study: a posthoc analysis. Lancet. 2010;376:1916–22.

    Google Scholar 

  125. Kennedy WP. The nocebo reaction. Med. WORLD. 1961;95:203–5.

    Google Scholar 

  126. Matthew A, Herrett E, Gasparrini A, et al. Impact of statin related media coverage on use of statins: interrupted time series analysis with UK primary care data. BMJ. 2016;353:i3283.

    Google Scholar 

  127. Nielsen SF, Nordestgaard BG. Negative statin-related news stories decrease statin persistence and increase myocardial infarction and cardiovascular mortality: a nationwide prospective cohort study. Eur Heart J. 2016;37:908–16.

    Google Scholar 

  128. Webster RK, Weinman J, Rubin GJ. A systematic review of factors that contribute to nocebo effects. Health Psychol. 2016;35:1334–55.

    Google Scholar 

  129. Gupta A, Thompson D, Whitehouse A, et al. Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian cardiac outcomes trial-lipid-lowering arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet. 2017;389:2473–81.

    Google Scholar 

  130. Goldacre B, van Staa T, MacDonald TM, et al. Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials. BMJ. 2021;372:n135.

    Google Scholar 

  131. Rosenson R, Baker S, Jacobson T, et al. An assessment by the statin muscle safety task force: 2014 update. J Clin Lipidol. 2014;8:S58–71.

    Google Scholar 

  132. Boccuzzi S, Bocanegra T, Walker F, et al. Long-term safety and efficacy of simvastatin. Am J Cardiol. 1991;68:1127–31.

    Google Scholar 

  133. Collins R, Reith C, Emberson J, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2016;388:2532–61.

    Google Scholar 

  134. More V, Cheng Q, Donepudi A, et al. Alcohol cirrhosis alters nuclear receptor and drug transporter expression in human liver. Drug Metab Dispos. 2013;41:1148–55.

    Google Scholar 

  135. Pose E, Napoleone L, Amin A, et al. Safety of two different doses of simvastatin plus rifaximin in decompensated cirrhosis (LIVERHOPE-SAFETY): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Gastroenterol Hepatol. 2020;5:31–41.

    Google Scholar 

  136. Muñoz AE, Pollarsky F, Marino M, et al. Safety of chronic simvastatin treatment in patients with decompensated cirrhosis: many adverse events but no liver injury. Dig Dis Sci. 2021;66:3199–208.

    Google Scholar 

  137. Russo MW, Scobey M, Bonkovsky HL. Drug-induced liver injury associated with statins. Semin Liver Dis. 2009;29:412–22.

    Google Scholar 

  138. Tsochatzis EA, Bosch J. Statins in cirrhosis-ready for prime time. Hepatology. 2017;66:697–9.

    Google Scholar 

  139. Moctezuma-Velazquez C, Abraldes JG, Montano-Loza AJ. The use of statins in patients with chronic liver disease and cirrhosis. Curr Treat Options Gastroenterol. 2018;16:226–40.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alberto E. Muñoz .

Editor information

Editors and Affiliations

Ethics declarations

The authors declare no conflicts of interest.

Financial Support

No funding was received to design and undertake this study and to write this manuscript. In most cases, when research and studies are initiated and conducted in Argentina by the researchers, there is no funding from any public or private institution as they are made with financial contributions from the researchers.

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Muñoz, A.E., Cartier, M., Kisch, A.B. (2022). Statins in Liver Cirrhosis. In: Qi, X., Yang, Y. (eds) Pharmacotherapy for Liver Cirrhosis and Its Complications. Springer, Singapore. https://doi.org/10.1007/978-981-19-2615-0_12

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-2615-0_12

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-2614-3

  • Online ISBN: 978-981-19-2615-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics