Use of Statins in Patients With and Without Liver Disease

Francis, Prashanth; Forman, Lisa

doi:10.1002/cld.866

Cited by 10 publications

(16 citation statements)

References 40 publications

(64 reference statements)

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Section: Discussionmentioning

confidence: 99%

“…27,28 Francis and Forman reported that clinically relevant risks to the liver from statins remain remarkably low in patients without cirrhosis and should not outweigh the broad cardiovascular and potential hepatic benefits. 29 Due to the lack of evidence between statin use and severe liver injury, the National Lipid Association's Liver Expert Panel concluded that routine liver function monitoring might inappropriately encourage doctors to discontinue statin therapy upon detection of liver enzyme elevations. 30 Likewise, the FDA concurs that routine periodic monitoring of liver enzymes does not appear to be effective in detecting or preventing serious liver injury given the rarity and unpredictability of serious liver injury with statins in individual patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Statin Use and Severe Acute Liver Injury Among Patients with Elevated Alanine Aminotransferase

Verma¹,

Huang²,

Hutchinson³

et al. 2022

CLEP

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Introduction While serious liver injury among statin users is extremely rare, baseline liver enzyme testing is still recommended prior to initiating therapy. The benefit of such screening should be reevaluated based on empirical evidence. This study compared the risk of severe acute liver injury (SALI) between statin initiators with an elevated ALT (>35U/L) matched to statin initiators with a normal ALT level (≤35U/L). Statin initiators with an elevated ALT were additionally compared against matched non-users. Methods The study created cohorts from Optum and MarketScan claims data. Exposed and comparison cohorts were propensity score (PS) matched in each dataset and findings were pooled using meta-analysis. Proportional hazards regression was used to estimate hazard ratios (HRs), and a prespecified non-inferiority margin for SALI was set at a HR of 1.8. Results 232,889 patients with elevated ALT were PS-matched to 232,889 with normal ALT level. The overall incidence rate of SALI was about 19/100,000 person-years among statin initiators. Statin initiators with elevated ALT had no meaningfully increased risk of SALI compared to those with normal ALT (HR=1.15; 95% CI 0.75 to 1.75). Comparing statin initiators with non-initiators with elevated ALT values equally yielded no increased risk (HR=0.76; 95% CI 0.52 to 1.11). Conclusion In this large population-based study, SALI in statin users was rare. Importantly, the results showed no evidence that baseline ALT status is a reliable indicator for an increased risk of severe liver injury among statin initiators.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Statin Use and Severe Acute Liver Injury Among Patients with Elevated Alanine Aminotransferase

Verma¹,

Huang²,

Hutchinson³

et al. 2022

CLEP

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“…This is in line with small prospective and larger retrospective studies that found statins to be safe in compensated cirrhosis. ( 39 ) Further studies are currently being performed assessing the safety and efficacy of different doses of statins in patients with decompensated cirrhosis. ( 40 ) In fact, we could not exactly determine the defined daily doses, and information on type or dose was not available in a subgroup of our patients.…”

Section: Discussionmentioning

confidence: 99%

Protective Effects of Statin Therapy in Cirrhosis Are Limited by a Common SLCO1B1 Transporter Variant

et al. 2021

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Complications of cirrhosis and portal hypertension (PH) can be reduced by statin therapy. The common loss-of-function variant p.V174A in the solute carrier organic anion transporter gene 1B1 (SLCO1B1) gene encoding the organic anion transporting polypeptide 1B1 results in decreased hepatic uptake of statins. Our specific aim was to assess the impact of this variant in patients with cirrhosis and statin treatment while controlling for the stage of cirrhosis and other potential confounders with propensity score matching (PSM), availing of a large cohort of genotyped study patients. In total, from 1,088 patients with cirrhosis in two German academic medical centers, PSM yielded 154 patients taking statins and 154 matched controls. The effect on PH was assessed by the liver stiffness-spleen size-to-platelet score (LSPS), and complications of cirrhosis were retrospectively recorded applying consensus criteria. As hypothesized, patients on statin treatment presented less frequently with signs of PH: Esophageal varices (41% vs. 62%; P < 0.001) were less common, and LSPS (4.8 ± 11.5 vs. 5.6 ± 6.4; P = 0.01) was reduced. Correspondingly, decompensation events were also reduced in patients on statins (odds ratio [OR] = 0.54, 95% confidence interval [CI] 0.32-0.90; P = 0.02). When the variant in SLCO1B1 was present in patients on statins, esophageal varices (OR = 2.68, 95% CI 1.24-5.81; P = 0.01) and bacterial infections (OR = 2.50, 95% CI 1.14-5.47; P = 0.02) were more common as compared with wild type carriers on statins. Conclusion: In this cohort, signs and complications of PH were reduced in patients with cirrhosis treated with statins. Notably, this effect was diminished by the common loss-of-function variant in SLCO1B1. Further prospective studies in independent cohorts are warranted to confirm these genotype-specific observations. (Hepatology Communications 2021;0:1-12).

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“…(2) The underlying mechanisms for these benefits are not limited to low-density lipoprotein-lowering effects, but instead reflect a pleiotropic model in which complex changes in cellular signaling result in multimodal mechanisms of action that include anti-inflammatory, antifibrotic, and antioncogenic pathways. (1) In light of these pleiotropic effects, it is not surprising that benefits of statins have been found beyond cardiovascular event reduction. In addition to the aforementioned hepatoprotective effects, there is evidence suggesting a beneficial role of statins in the prevention of venous and arterial thrombosis.…”

Section: See Article On Page 1432mentioning

confidence: 99%

HATs Off to Clot Blockers: A Potential New Role for Statins After Transplantation

Francis

Forman

2021

Liver Transpl

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Use of Statins in Patients With and Without Liver Disease

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-1-reading-prashanth a video presentation of this article https://aasldpubs.onlinelibrary.wiley.com/hub/journal/20462484/video/15-1-interview-francis an interview with the author

Cited by 10 publications

References 40 publications

Statin Use and Severe Acute Liver Injury Among Patients with Elevated Alanine Aminotransferase

Statin Use and Severe Acute Liver Injury Among Patients with Elevated Alanine Aminotransferase

Protective Effects of Statin Therapy in Cirrhosis Are Limited by a Common SLCO1B1 Transporter Variant

HATs Off to Clot Blockers: A Potential New Role for Statins After Transplantation

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