Underutilization of Statin Therapy Among Patients with NAFLD in the USA: Validation with Big Data

Abstract

We read with interest the article by Blais et al. [1] recently published in the Journal. In an analysis of a random sample of 255 patients with Nonalcoholic Fatty Liver Disease (NAFLD) in the Veteran Affairs (VA) hospital system with dyslipidemia, only 152 (59.6 %) were on statin therapy. We sought to validate these findings in larger, non-VA hospital systems in the USA. Additionally, because women are greatly underrepresented in the VA cohort (5 %), we sought to identify gender differences in statin use.We used Explorys (Cleveland, OH), a private clinical registry based on billing codes, electronic medical records, and laboratory results from 26 major healthcare organizations and 360,000 providers covering about 50 million unique lives in the USA [2]. Using International Classification of Diseases version 9 code 571.8, we identified patients with NAFLD (age 18-65 years) and low-density lipoprotein (LDL) levels of C190 mg/dL (class I indication for statin therapy in the adult treatment panel guidelines [3]). We excluded patients with AST or ALT Cthree times upper limit of normal.We identified 9960 patients with NAFLD and LDL C190 mg/dL (59 % female, 82 % Caucasians). Diabetes was diagnosed in 44 % of the patients, and 73 % had hypertension. Overall, 7030 (71 %) of the patients had a statin prescription. There was no difference in statin prescription between males and females (p = 0.86). However, African Americans had a higher rate of statin prescription than Caucasians (76 vs. 70 %, p \ 0.001).In summary, our findings of a large non-VA ''realworld'' cohort of NAFLD with significant LDL elevation showed underutilization of statin in this high-risk population. There seems to be a small racial disparity, but no gender differences were observed in statin utilization. Quality improvement projects should focus on optimization of statin utilization in this patient population.

Simvastatin Reduces Hepatic Oxidative Stress and Endoplasmic Reticulum Stress in Nonalcoholic Steatohepatitis Experimental Model

“…In the evaluation of hepatocellular damage, aminotransferase alterations were observed in the animals that received the MCD diet. There are reported cases of statin-related hepatotoxicity, but although elevated aminotransferases are not uncommon in patients receiving statins, serious liver injury from statins is rarely seen in clinical practice [27]. The use of SIM in animals with NASH reduced the levels of these enzymes and reduced the hepatocyte injury.…”

Aspirin use and risk of cholangiocarcinoma: External validation with big data

“…This database has been used and validated in different fields of medicine, including gastroenterology. (3)(4)(5) We identified patients with pharmacy data who are at least 50 years old seen at participating institutions from 1999 to 2016. Similarly to Choi et al, we identified diagnoses of cholangiocarcinoma using International Classification of Diseases, Ninth Revision, as follows: 155.1, 156.1, 156.2, 156.8, and 156.9.…”

Prevalence of autoimmune, cholestatic and nonalcoholic fatty liver disease in celiac disease

“…Plausible explanations include underdiagnosis of these diseases and failure to accurately record them during inpatient admissions. This, however, should not affect the results of our study as previous studies from this database have been published and validated against studies from other databases [24,25,49]. Certain risk factors such as HLA haplotypes (especially for AIH, PBC and PSC cohorts), family history and the impact of pharmacological interventions (such as corticosteroid use in case of NAFLD) could not be assessed.…”