Statin use cuts risks in compensated cirrhosis
Guadalupe Garcia-Tsao, MD, is professor of medicine at Yale
University, chief of digestive diseases at the VA-CT Healthcare
System, and director of the clinical core of the Yale Liver Center,
New Haven, Conn. She had no conflicts of interest.
The main mechanism in the development of cirrhosis in patients with chronic liver disease (CLD) is increased he- patic fibrogenesis. The initial consequence of cirrhosis is
portal hypertension, which is the main
driver of decompensation (defined as
the presence of ascites, variceal hemorrhage, or encephalopathy).
Portal hypertension initially results
from an increase in intrahepatic resistance, which in turn results from
distortion of liver vascular architecture
(mostly due to fibrosis) and from intrahepatic vasoconstriction (mostly due to
endothelial cell dysfunction).
Statins are widely used for reducing
cholesterol levels and cardiovascular
risk. However, statins ameliorate endothelial dysfunction and have additional antifibrotic, anti-inflammatory,
and antithrombotic properties, all of
them of potential benefit in preventing
progression of CLD/cirrhosis. In fact,
statins have been shown to reduce portal pressure in cirrhosis.
In a meta-analysis of 13 studies, Kim
et al. demonstrated that statin use is
associated with a 58% lower risk of de-
veloping cirrhosis/fibrosis progression
in patients with CLD (not statistically
significant), while in patients with
compensated cirrhosis of any etiology,
statin use was associated with a sta-
tistically significant 46% lower risk of
developing decompensation and death.
Most studies in the meta-analysis
Although the authors jointly analyzed
three randomized controlled trials,
only one of the trials looked at clinical
outcomes. This important double-blind,
placebo-controlled study in patients
with recent variceal hemorrhage
showed a significantly lower mortality
in patients randomized to simvastatin.
Therefore, although the evidence is
not yet sufficient to recommend the
widespread use of statins in patients
with CLD/cirrhosis, providers should
not avoid using statins in patients
with CLD/cirrhosis who otherwise
need them. In fact, they should actively look for indications that would justify their use. n
Key clinical point: Statin therapy
was associated with a significantly
lower risk of hepatic decompensation, death, and progressive portal hypertension in patients with
chronic liver diseases with compensated cirrhosis.
Major finding: For these patients,
statin therapy was associated with
about a 46% decrease in the risk of
hepatic decompensation and mortality (risk ratios, 0.54) and with
a 27% drop in the risk of portal
hypertension and variceal bleeding
Data source: A systematic review
and meta-analysis of 10 cohort
studies and three randomized controlled trials (121,058 patients).
Disclosures: The reviewers acknowledged the American Gastro
enterological Association Foundation, a T. Franklin Williams Scholarship Award, the National Institutes
of Health, and the National Library
of Medicine. They reported having
no relevant conflicts of interest.
October Clinical Gastroenterology and Hepatology (doi: 10.1016/ j.cgh.2017.04.039)