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Statins decrease the risk of decompensation in hepatitis B virus- and hepatitis C virus-related cirrhosis: A
Fu-Ming Chang1,2,3, Yen-Po Wang1,3,4,5, Hui-Chu Lang6
1Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan.
Insights
Statin use significantly lowers the risk of decompensation, mortality, and liver cancer in patients with cirrhosis from hepatitis B or C. Benefits were dose-dependent and observed in a large Taiwanese cohort.
Area of Science:
- Hepatology
- Clinical Pharmacology
- Gastroenterology
Background:
- Statin use is known to reduce decompensation and mortality in hepatitis C virus (HCV) related cirrhosis.
- The effects of statins on cirrhosis from other causes like hepatitis B virus (HBV) or alcohol are not well-established.
- Statin's role in preventing hepatocellular carcinoma (HCC) in patients with pre-existing cirrhosis is also unclear.
Purpose of the Study:
- To investigate the impact of statin use on decompensation, mortality, and HCC rates in patients with HBV, HCV, and alcohol-related cirrhosis.
- To determine if statin's benefits extend beyond HCV-related cirrhosis to other etiologies.
- To assess the dose-response relationship between statin use and these adverse outcomes.
Main Methods:
- A cohort of 1350 patients with cirrhosis was identified from Taiwan's National Health Insurance beneficiaries (2000-2013).
- Statin users (cumulative defined daily dose [cDDD] ≥28) were compared with matched non-users (<28 cDDD) using propensity scores.
- The association between statin use and risks of decompensation, mortality, and HCC was analyzed using regression models.
Main Results:
- Statin use demonstrated a dose-dependent reduction in decompensation, mortality, and HCC risk among all cirrhosis patients.
- Significantly lower decompensation risk was observed in statin users with HBV-related (HR 0.39) and HCV-related (HR 0.51) cirrhosis.
- A trend towards reduced decompensation risk was noted for alcohol-related cirrhosis (HR 0.69), though not reaching statistical significance.
Conclusions:
- Statin therapy effectively decreases decompensation rates in both HBV- and HCV-related cirrhosis.
- A potential, though not statistically significant, benefit in reducing decompensation was observed for alcohol-related cirrhosis.
- Findings support the broader application of statins in managing cirrhosis patients across different etiologies.
Abstract:
Statin use decreases the risk of decompensation and mortality in patients with cirrhosis due to hepatitis C virus (HCV). Whether this beneficial effect can be extended to cirrhosis in the general population or cirrhosis due to other causes, such as hepatitis B virus (HBV) infection or alcohol, remains unknown. Statin use also decreases the risk of hepatocellular carcinoma (HCC) in patients with chronic HBV and HCV infection. It is unclear whether the effect can be observed in patients with pre-existing cirrhosis. The goal of this study was to determine the effect of statin use on rates of decompensation, mortality, and HCC in HBV-, HCV-, and alcohol-related cirrhosis. Patients with cirrhosis were identified from a representative cohort of Taiwan National Health Insurance beneficiaries from 2000 to 2013. Statin users, defined as having a cumulative defined daily dose (cDDD) ≥28, were selected and served as the case cohort. Statin nonusers (<28 cDDD) were matched through propensity scores. The association between statin use and risk of decompensation, mortality, and HCC were estimated. A total of 1350 patients with cirrhosis were enrolled. Among patients with cirrhosis, statin use decreased the risk of decompensation, mortality, and HCC in a dose-dependent manner (P for trend <0.0001, <0.0001, and 0.009, respectively). Regression analysis revealed a lower risk of decompensation among statin users with cirrhosis due to chronic HBV (adjusted hazard ratio [HR], 0.39; 95% confidence interval [CI], 0.25-0.62) or HCV infection (HR, 0.51; 95% CI, 0.29-0.93). The lowered risk of decompensation was of borderline significance among statin users with alcohol-related cirrhosis (HR, 0.69; 95% CI, 0.45-1.07).
Conclusion:
Statin use decreases the decompensation rate in both HBV- and HCV-related cirrhosis. Of borderline significance is a decreased decompensation rate in alcohol-related cirrhosis. (Hepatology 2017;66:896-907).
