Beneficial Effects of Statins on the Rates of Hepatic Fibrosis, Hepatic Decompensation, and Mortality in Chronic Liver Disease: A Systematic Review and Meta-Analysis

Kamal, Sehrish; Khan, Muhammad Ali; Seth, Ankur; Cholankeril, George; Gupta, Divyansh; Singh, Utkarsh; Kamal, Faisal; Howden, Colin W.; Stave, Christopher D; Nair, Satheesh; Ahmed, Aijaz

doi:10.1038/ajg.2017.170

Cited by 91 publications

(63 citation statements)

References 50 publications

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“…Statins have received increasing attention as having benefits beyond their lipid‐lowering properties in patients with chronic liver disease. These drugs decrease fibrogenesis, reduce portal hypertension, improve liver function, protect against severe hepatic complications including ischemia/reperfusion injury, and reduce the risk of cirrhosis and hepatocellular carcinoma . The underlying mechanisms are probably related to statins reversing endothelial dysfunction in the hepatic microcirculation, improving inflammation, and in inducing tumor apoptosis and cell‐cycle arrest .…”

supporting

confidence: 52%

“…The underlying mechanisms are probably related to statins reversing endothelial dysfunction in the hepatic microcirculation, improving inflammation, and in inducing tumor apoptosis and cell‐cycle arrest . Recently, multiple large studies have been published involving patients with chronic liver disease and compensated cirrhosis, confirming the safety of statin medications in this cohort . However, data on statin safety in decompensated cirrhosis are lacking.…”

mentioning

confidence: 99%

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Asprin and statin use for management of atherosclerotic cardiovascular disease in liver transplant candidates: Are we missing the mark?

VanWagner¹

2018

Liver Transpl

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supporting

confidence: 52%

mentioning

confidence: 99%

Asprin and statin use for management of atherosclerotic cardiovascular disease in liver transplant candidates: Are we missing the mark?

VanWagner¹

2018

Liver Transpl

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“…There are currently no data regarding the safety of statin therapy in patients with decompensated cirrhosis. In a recent meta‐analysis of patients with compensated cirrhosis, use of statins was associated with a reduction of portal pressure and no significant increase in hepatic decompensation . In the current cohort study, we build on these data to show that statin therapy does not increase the risk of hepatic decompensation or mortality and is safe to use in patients with decompensated cirrhosis.…”

Section: Discussionmentioning

confidence: 88%

Utilization of aspirin and statin in management of coronary artery disease in patients with cirrhosis undergoing liver transplant evaluation

Patel

Guzmán

Lin³

et al. 2018

Liver Transpl

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Coronary artery disease (CAD) assessment is a vital part of liver transplantation (LT) evaluation, as it allows for identification and medical optimization prior to transplantation. Although aspirin and statins are standard of care for CAD, they are not universally used in cirrhosis due to concerns about adverse events. Per protocol, coronary angiography was performed as part of the LT evaluation in all patients over the age of 50 years or with CAD risk factors, even if they were younger than 50. Optimal CAD medical management was defined as the use of both statin and aspirin, unless a contraindication was documented. Impact of these medications on hepatic decompensation, renal function, gastrointestinal bleeding, and need for transfusion was evaluated. CAD was detected in 84/228 (36.8%) patients. Lipid profile was similar in patients with and without CAD. In patients with CAD, statins were started in 19 (23%), while aspirin was used in 30 (36%) patients. In patients with obstructive or multivessel CAD, statin therapy was used only in 41% and 65%, respectively. Statins were more likely to be prescribed in patients with diabetes (32% versus 15%, P = 0.05) and history of dyslipidemia (38% versus 15%, P = 0.02). Use of statin therapy was not linked to hepatic decompensation, hospitalization, or rise in Model for End-Stage Liver Disease (MELD). Similarly, use of aspirin therapy was not associated with increased risk acute variceal hemorrhage, gastrointestinal bleeding, or worsening anemia. In conclusion, in decompensated cirrhosis, lipid profile alone is unable to risk stratify patients with CAD. Statin and aspirin appear to be safe. However, they are significantly underutilized for the management of CAD in this patient population. Liver Transplantation 24 872-880 2018 AASLD.

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“…In patients with cirrhosis (80% alcoholic), cross‐sectional evidence from computed tomography angiographies shows a high prevalence of severe coronary stenosis . It appears that statins reduce their mortality and rate of hepatic decompensation . Moreover, MI runs a particularly grave course in these patients and they have an increased mortality due to ischaemic heart disease .…”

Section: Introductionmentioning

confidence: 99%

Time‐dependent incidence and risk for myocardial infarction in patients with alcoholic cirrhosis

Deleuran

Schmidt

Vilstrup

et al. 2020

Eur J Clin Investigation

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Background It remains unsettled whether alcoholic cirrhosis is a risk factor for myocardial infarction (MI). Methods We used data from nationwide healthcare registries to study all Danes diagnosed with alcoholic cirrhosis in 1996‐2014, and five controls were matched to each of them on gender and age. We excluded everyone with ischaemic heart disease and used Cox regression to estimate the incidence rate ratio of MI adjusted for potential cardiovascular confounders. Further, we described the MI‐risk with non‐MI death as a competing risk. Results We included 22 867 patients (67% men) with a median age of 57 years. During the first year of follow‐up, their incidence rate ratio of MI was increased to 1.24 (95% CI: 0.94‐1.62), driven by the effect among women (2.13, 95% CI: 1.17‐3.87) and those with most severe cirrhosis (1.32, 95% CI: 0.91‐1.90). After the first year, the overall incidence rate ratio fell to (0.89, 95% CI: 0.76‐1.05). Patients were more likely to die from non‐MI causes (33.7% vs 1.0%), which protected them against MI. The overall 1‐year MI‐risk was similar in patients and controls: 0.38% (95% CI: 0.30‐0.47%) vs 0.34% (95% CI: 0.31‐0.38%). After five years of follow‐up, male patients had lower MI‐risk than their controls, whereas women with cirrhosis had an increased MI‐risk throughout follow‐up. Conclusions The incidence rate of MI was increased the first year following a diagnosis of alcoholic cirrhosis, in particular in women and those with most severe liver disease. Due to the competing risk of non‐MI mortality, the MI‐risk was not increased.

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Beneficial Effects of Statins on the Rates of Hepatic Fibrosis, Hepatic Decompensation, and Mortality in Chronic Liver Disease: A Systematic Review and Meta-Analysis

Abstract: Statins may retard the progression of hepatic fibrosis, may prevent hepatic decompensation in cirrhosis, and may reduce all-cause mortality in patients with CLD. As the quality (certainty) of evidence is low, further studies are needed before statins can be routinely recommended.

Cited by 91 publications

References 50 publications

Asprin and statin use for management of atherosclerotic cardiovascular disease in liver transplant candidates: Are we missing the mark?

Asprin and statin use for management of atherosclerotic cardiovascular disease in liver transplant candidates: Are we missing the mark?

Utilization of aspirin and statin in management of coronary artery disease in patients with cirrhosis undergoing liver transplant evaluation

Time‐dependent incidence and risk for myocardial infarction in patients with alcoholic cirrhosis

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