Statins Are Associated With a Decreased Risk of Decompensation and Death in Veterans With Hepatitis C–Related Compensated Cirrhosis

Mohanty, Arpan; Tate, Janet P.; García–Tsao, Guadalupe

doi:10.1053/j.gastro.2015.10.007

Cited by 173 publications

(177 citation statements)

References 39 publications

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“…Of the 1706 unique studies identified using our search criteria, 13 studies met our inclusion criteria and were included in our meta-analysis (3 RCTs and 10 observational studies) 33–43, 50, 51 Six studies included participants with non-cirrhotic CLDs 35, 39–43 , six studies included participants with compensated cirrhosis 36, 37, 42, 43, 50, 51 , and three studies included individuals with decompensated cirrhosis 33, 34, 38 . One study was excluded as it represented a population already included in another, more recent study; 52 one small RCT of statins in NASH was excluded due to insufficient information 53 .…”

Section: Resultsmentioning

confidence: 99%

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Statin Use and Risk of Cirrhosis and Related Complications in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis

Kim

Loomba

Prokop

et al. 2017

Clinical Gastroenterology and Hepatology

146

112

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Background & Aims Statins have been variably shown to decrease risk and complications of chronic liver diseases (CLDs). We performed a systematic review and meta-analysis to evaluate the association between statins and risk of cirrhosis and related complications in patients with CLDs. Methods Through a systematic literature search up to March 2017, we identified 13 studies (3 randomized trials, 10 cohort studies) in adults with CLDs, reporting the association between statin use and risk of development of cirrhosis, decompensated cirrhosis, improvements in portal hypertension, or mortality. Pooled relative risk (RR) estimates with 95% CIs were calculated using random effects model. GRADE criteria were used to assess quality of evidence. Results Among 121,058 patients with CLDs (84.5% with hepatitis C), 46% were exposed to statins. In patients with cirrhosis, statin use was associated with 46% lower risk of hepatic decompensation (4 studies; RR, 0.54; 95% CI, 0.46–0.62; I2=0%; moderate quality evidence), and 46% lower mortality (5 studies; RR, 0.54; 95% CI, 0.47–0.61; I2=10%; moderate quality evidence). In patients with CLD without cirrhosis, statin use was associated with a non-significant (58% lower) risk of development of cirrhosis or fibrosis progression (5 studies; RR, 0.42; 95% CI, 0.16–1.11; I2=99%; very low quality evidence). In 3 randomized controlled trials, statin use was associated with 27% lower risk of variceal bleeding or progression of portal hypertension (hazard ratio, 0.73; 95% CI, 0.59–0.91; I2=0%; moderate quality evidence). Conclusion Based on a systematic review and meta-analysis, statin use is probably associated with lower risk of hepatic decompensation and mortality, and might reduce portal hypertension, in patients with CLDs. Prospective observational studies and randomized controlled trials are needed to confirm this observation.

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Section: Resultsmentioning

confidence: 99%

“…Four studies reported on risk of progression to decompensated cirrhosis, in patients baseline compensated cirrhosis 36, 37, 50 or non-cirrhotic CLDs 35 . Three studies relied on validated administrative claims codes for development of decompensated cirrhosis, and one used individual medical record review.…”

Section: Resultsmentioning

confidence: 99%

Statin Use and Risk of Cirrhosis and Related Complications in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis

Kim

Loomba

Prokop

et al. 2017

Clinical Gastroenterology and Hepatology

146

112

View full text Add to dashboard Cite

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“…No differences in comorbidities, metabolic conditions, or hepatic function were reported between groups. The positive effect of statins in cirrhosis decompensation and mortality persisted at 10 years after adjustment for age, FIB-4 index score, serum level of albumin, model for end-stage liver disease (MELD), and Child-Turcotte-Pugh (CPT) scores [52•]. …”

Section: Clinical Studiesmentioning

confidence: 99%

Use of Statins in Patients with Chronic Liver Disease and Cirrhosis: Current Views and Prospects

Vargas

Arrese

Shah

et al. 2017

Curr Gastroenterol Rep

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Purpose of review The purpose of this study is to analyze the current evidence regarding the use of statins in patients with chronic liver disease and cirrhosis. Recent findings Chronic liver disease (CLD), cirrhosis, and its complications, including hepatocellular carcinoma (HCC), are significant public health problems. The use of statins in patients with CLD has been a matter of concern, and physicians are often reluctant to its prescription in these patients. This mainly relates to the potential occurrence of drug-induced liver injury. However, newer evidence from pre-clinical and clinical research has shown that statins are drugs with a potentially beneficial impact on the natural history of cirrhosis, on portal hypertension, and in HCC prevention. Summary In this review, we summarize current evidence regarding the influence of statins in endothelial dysfunction in CLD, their ability to modulate hepatic fibrogenesis, and their vasoprotective effects in portal hypertension; we also focus on existing data about the impact of statins in cirrhosis development, progression, and complications and critically assess the current concerns about its use in patients with CLD.

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“…1,[7][8][9] Statins are considered safe in cirrhosis and several studies have shown reduction of portal hypertension, lower rates of decompensation, risk of hepatocellular carcinoma, and mortality in patients on statins. [10][11][12] As patients with liver disease are more prone for statin-induced myopathy, statins should be kept in differential diagnosis of muscle-related symptoms in these patients. It should be used judiciously in these patients with close clinical monitoring for any muscle related symptoms, and checking of creatine phosphokinase as needed.…”

mentioning

confidence: 99%

Acute Onset Significant Muscle Weakness in a Patient Awaiting Liver Transplantation: Look for Statins

Choudhary

Saigal

Saraf

et al. 2017

Journal of Clinical and Experimental Hepatology

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Statins are commonly used drugs in patients with liver and cardiac disease. Statin-induced severe myopathy is a very uncommon presentation and rhabdomyolysis may occur in extreme cases which leads to renal failure. Patients with comorbidities like diabetes, hypothyroidism, and liver disease have higher chances of development of statin-induced myopathy. We describe a case of Child's C cirrhosis wherein the patient had acute onset significant muscle weakness and improved on statin discontinuation. ( J CLIN EXP HEPATOL 2017;7:66-67) A 57-year-old male presented with history of generalized weakness and inability to walk for 4 days. He also felt fatigue of jaw muscles on chewing. There was no history of fever or sensory symptoms. He was diagnosed as a case of cryptogenic (possibly NASH related) cirrhosis with decompensation three and half years back when he developed jaundice and ascites. His co-morbidities included diabetes mellitus and hypothyroidism for 4 years. In addition, he also had morbid obesity (body mass index 34.08 kg/m 2 ). He was worked up for deceased donor liver transplantation. His child's score was 11 and MELD score was 20. He had normal electrolytes, 25(OH)D 34 ng/ ml (<20 taken as deficient) and thyroid function test (TSH 3.9 mu/ml, T3 2.6 pg/ml, T4 1.6 ng/dl). His lipid profile revealed low values of total cholesterol (51 mg/dl), lowdensity lipoprotein (30 mg/dl), high-density lipoprotein (8 mg/dl), and triglycerides 67 (mg/dl). During his pretransplant workup, he was diagnosed to have 95% stenosis of left anterior descending coronary artery during cardiac evaluation. He underwent coronary stent placement for the same and was started on low dose Atorvastatin as per post-coronary stenting cardiac protocol 19 days before the current admission. He presented with marked generalized weakness and inability to walk for 4 days. His other medications at the time of admission included Aspirin 75 mg, Clopidogrel 75 mg, Furosemide 20 mg, Spironolactone 50 mg, L-ornithine and L-aspartate, Rifaximine, Calcium, Norfloxacin 400 mg once a day (as primary prophylaxis for spontaneous bacterial peritonitis), and Injection Albumin 20% 100 ml intravenous twice a week. At admission, his investigations were as follows: hemoglobin 10.5 g/dl, total leukocyte count 6420/cmm (neutrophils 47%, lymphocytes 27%, monocytes 21%), platelet count 110,000/cmm, serum bilirubin 5.8 (direct 2.8) mg/dl, aspartate aminotransferase 214 IU/L (195 IU/L one month back), alanine aminotransferase 62 IU/L (28 IU/L one month back), normal Alkaline Phosphatase and Gamma-glutamyl Transpeptidase, albumin 2 g/dl, globulins 3.6 g/dl, INR 1.82, creatinine 0.6 mg/ dl, magnesium 1.9 (1.6-2.3 mg/dl), calcium 8.2 (8.4-10.2) mg/dl, potassium 4.6 mmol/l, and phosphate 3.7 (2.5-4.5) mg/dl; these levels remained within normal values at the time of symptom improvement also. A thorough neurology evaluation was done which revealed muscle power of 3/ 5 in lower limbs and 4/5 in upper limbs. He had normal sensory examination and plantar reflex was normal. His ...

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Statins Are Associated With a Decreased Risk of Decompensation and Death in Veterans With Hepatitis C–Related Compensated Cirrhosis

Cited by 173 publications

References 39 publications

Statin Use and Risk of Cirrhosis and Related Complications in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis

Statin Use and Risk of Cirrhosis and Related Complications in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis

Use of Statins in Patients with Chronic Liver Disease and Cirrhosis: Current Views and Prospects

Acute Onset Significant Muscle Weakness in a Patient Awaiting Liver Transplantation: Look for Statins

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