statins reduces the risk of decompensated liver disease for people with
cirrhosis caused by hepatitis B virus (HBV) and hepatitis C virus (HCV),
investigators from Taiwan report in the online edition of Hepatology. The treatment also modestly reduced the risk of
decompensated disease for people with alcohol-related cirrhosis.
that statin use may lower risk of decompensation in a dose-response manner by
around 50-60% among cirrhotic patients with chronic HBV or HCV infection, while
borderline effect was noted in alcoholic cirrhosis,” write the researchers. “The benefit
provided by statin use was mainly in decreasing the risk of ascites-related
complications and hepatic encephalopathy.”
Cirrhosis of the
liver can be caused by HBV, HCV or alcohol abuse. Decompensated cirrhosis is
associated with a poor prognosis. To avoid progression to decompensated
disease, early therapy is strongly advocated.
An accumulation of fluid in the abdomen; may be caused by liver damage, especially cirrhosis.
- decompensated cirrhosis
The later stage of
cirrhosis, during which the liver cannot perform some vital functions and
complications occur. See also ‘cirrhosis’ and ‘compensated cirrhosis’.
A disease or infection affecting the brain.
- hepatocellular carcinoma (HCC)
Liver cancer. A long-term complication of chronic inflammation of the liver or cirrhosis.
One such therapy
is statins. Research involving US veterans showed that statins were beneficial
for people with HCV-related cirrhosis, whereas research conducted in Taiwan revealed
that the therapy reduced the risk of decompensation for people with
HBV-related cirrhosis. However, this research had several limitations,
including small sample size or restricted patient population. The benefits of
statins for people with alcohol-related cirrhosis remains unclear, and it is
also unknown if statins reduce the risk of hepatocellular carcinoma (HCC) and
mortality in people with cirrhosis.
To establish a
clearer understanding of the benefits of statins for people with cirrhosis
due to multiple causes, investigators from Taiwan used their country’s national
health research database to see if the therapy reduced the risk of
decompensation, mortality and HCC occurrence among people with cirrhosis caused
by HBV, HCV and alcohol.
diagnosed with cirrhosis were eligible for inclusion. Statin use was defined as
daily therapy for at least 28 days. The case controlled study enrolled 675 people
who were treated with statins and 675 people who did not take this therapy. Individuals
received care between 2000 and 2013.
showed benefits of statin therapy. Compared with non-users, individuals prescribed
statins had significantly lower rates of decompensation (14% vs 29%; p <
0.0001), mortality (9% vs 18%; p < 0.0001) and occurrence of HCC (6% vs
10%; p = 0.0097). The overall benefit of statins was confirmed in multivariate
analysis that controlled for potential confounders, with statins associated
with a significantly lower risk of decompensation (aHR = 0.39; 95% CI,
0.30-0.50), mortality (aHR = 0.46; 95% CI, 0.34-0.63) and liver cancer (aHR =
0.52; 95% CI, 0.35-0.76).
There was a
dose-related response, with the benefits of statin therapy increasing with longer
duration of treatment.
Analysis of individuals with HBV-related cirrhosis revealed that, compared to non-users, statin
users had a significantly lower risk of decompensation (12% vs 31%; p <
0.001) and mortality (6% vs 19%; p < 0.001) but not HCC occurrence (9% vs
13%). Multivariate analysis confirmed that statin therapy reduced risk of
both decompensation (aHR = 0.39; 95% CI, 0.26-0.62) and mortality (aHR = 0.39;
95% CI, 0.21-0.72) but not liver cancer (aHR = 0.70; 95% CI, 0.40-1.25).
turned to people with HCV-related cirrhosis. Statin users had a
significantly lower rate of decompensation (14% vs 28%; p = 0.007), but not
mortality (12% vs 20%) or HCC occurrence (6% vs 14%). The reduced risk of
decompensation was confirmed in the multivariate analysis (aHR = 0.51; 95% CI,
0.29-0.93), which also showed that use of statins did not significantly reduce
the risk of mortality but had a borderline effect on occurrence of liver cancer
(aHR = 0.38; 95% CI, 0.14-1.04).
examined the benefits of statins for people with alcohol-related liver
disease. Statin users had a significantly lower rate of decompensation (17% vs
28%) but the mortality rate (11% vs 17%) and HCC occurrence rate (35 vs 4%) was
similar to that observed in non-statin users. Multivariate analysis showed that
statin therapy was associated with a trend for a lower risk of decompensation
(aHR = 0.69; 95% CI, 0.45-1.07) but had no benefit in terms of mortality or
progression to HCC.
Statins lowered the
risk of ascites and related complications, hepatic encephalopathy and variceal
decreased the decompensation rate in HBV- and HCV-related cirrhosis, while
borderline effect was noted in alcoholic cirrhosis,” conclude the authors. “Statins
may be considered as an adjuvant therapy to prevent decompensation among
cirrhotic patients. Future prospective studies are needed to confirm our