Statin Use in Patients with Cirrhosis: A Retrospective Cohort Study
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Statins reduce cardiovascular risk. Patients with cirrhosis have decreased hepatic clearance of statins and potentially increased risk for complications. No studies assess mortality in patients with biopsy-confirmed cirrhosis.
Compare mortality in patients with cirrhosis on statins to those not on statins.
A retrospective cohort study evaluated patients from 1988 to 2011 at Partners Healthcare Hospitals. The Partners Research Patient Data Registry identified patients with biopsy-proven cirrhosis on statins at biopsy and at least 3 months following. Controls were matched 1:2 by age, gender and Child–Pugh class. Decompensation was defined as ascites, jaundice/bilirubin >2.5 mg/dL, and/or hepatic encephalopathy or variceal hemorrhage. Primary outcome was mortality. Secondary outcome was decompensation in baseline-compensated patients. Chi-square and two-way ANOVA testing compared groups. Cox proportional hazards models for mortality controlled for age, Child–Pugh class, diabetes, coronary artery disease, non-alcoholic steatohepatitis and hepatocellular carcinoma. Kaplan–Meier curves graphed mortality.
Eighty-one statin users and 162 controls were included. Median follow-up: 36 months in statin users and 30 months in controls. 70.4 % of patients were Child–Pugh A. Model for End-Stage Liver Disease (MELD), albumin, varices and beta-blocker use were not significantly different between groups. Statin users had lower mortality on multivariate analysis (HR 0.53, p = 0.01), and Child–Pugh A patients had longer survival on Kaplan–Meier analysis. Cox multivariate analysis for decompensation showed lower risk of decompensation with statins while increased decompensation with low albumin, high MELD score and beta-blocker use.
In patients with cirrhosis, statin therapy is not associated with increased mortality and may delay decompensation.
KeywordsStatins Cirrhosis Decompensation Child–Pugh
Conflict of interest
- 27.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;46:1453–1463.PubMedCrossRefGoogle Scholar
- 29.Cohen DE, Anania FA, Chalasani N, National lipid association statin safety task force liver expert panel. An assessment of statin safety by hepatologists. Am J Cardiol. 2006;97:77C–81C.Google Scholar
- 35.Cholesterol Treatment Trialists’ (CTT) Collaborators, Kearney PM, Blackwell L et al. Efficacy of cholesterol lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008;371:117–125.Google Scholar
- 38.PDR Staff. Physicians’ desk reference. PDR Network; 2011.Google Scholar