Simvastatin Lowers Portal Pressure in Patients With Cirrhosis and Portal Hypertension: A Randomized Controlled Trial

Prescribing a Statin to a Cirrhotic Patient to Reduce Hepatic Decompensation and Improve Survival: Impossible You Say?

“…Nevertheless, the duration of statin use needed to provide the benefits of preventing hepatic decompensation and prolonging survival cannot be determined from the discussed study, as the investigators did not analyze these outcomes for statins taken for more than 3 months. They justified the 3-month time frame based on Abraldes et al [10] who reported a significant reduction in the hepatic venous pressure gradient after just 1 month of daily simvastatin. Nevertheless, their study leaves open the question of whether long-term use (i.e., years) of a statin provides any ongoing, additional or cumulative benefits compared to relatively short-term use (i.e., months).…”

“…As mentioned above, controlled observations support a significant reduction in portal hypertension with statins [10], and antiviral effects of these medications have been increasingly reported [3,14].…”

“…Interestingly, while ascites was observed more often in the control group (31 vs 16 %), the effect on variceal bleeding was the opposite, with a higher rate reported in those taking statins (11 vs 2 %). Since just over one-third of the patients had varices at the time of enrollment, the failure to reduce bleeding from varices was an unexpected and unexplained finding, especially since statins can reduce portal pressure after just 1 month of use [10]. There were no differences between the two groups in terms of developing jaundice or hepatic encephalopathy.…”

“…Perhaps some patients stopped taking a beta blocker during the course of the study. Such knowledge might also help explain why the risk of variceal hemorrhage was not reduced among the statin users, despite the expected reduction in portal pressure attributed to their use [10]. Yet another limitation of their analysis involved the inability of the investigators to provide information regarding the efficacy of statins on the baseline levels of total cholesterol or LDL, as these data were not collected.…”

“…While it would be easy to call for additional studies to confirm the findings of reduced mortality in cirrhotics receiving a statin before considering their routine use in this setting, the time and effort required to perform such long-term follow-up studies would be substantial. With the current literature supporting safe use in CLD [1][2][3][4]6] as well as substantial clinical benefits [6,[8][9][10][11][12][13][14] with no serious adverse consequences, we already have sufficient evidence to recommend statins in our patients with cirrhosis at this time. As the saying goes, ''The difficult we do immediately.…”