Statins in Gastroenterology: Mechanisms, Human Evidence, and Safety

Area of Science:

• Gastroenterology and Hepatology
• Pharmacology
• Immunology

Background:

• Statins, primarily lipid-lowering drugs, possess pleiotropic effects impacting inflammation, vascular function, and immune responses.
• These mechanisms suggest potential therapeutic roles in various gastrointestinal diseases beyond their established cardiovascular benefits.

Purpose of the Study:

• To review current evidence on the safety and efficacy of statin repurposing in gastrointestinal and liver diseases.
• To explore the clinical impact of statins on disease progression, complications, and treatment outcomes in specific gastrointestinal conditions.

Main Methods:

• Systematic review of human data, including randomized controlled trials, cohort studies, and registry data.
• Analysis of clinical outcomes such as disease progression, decompensation events, hepatocellular carcinoma incidence, and inflammatory markers.

Main Results:

• Statin use is safe in metabolic dysfunction-associated steatotic liver disease, alcohol-associated liver disease, and viral hepatitis, correlating with slower progression and reduced complications.
• In cirrhosis, statins lower portal pressure and are linked to fewer variceal bleeds, ascites, and hepatic encephalopathy.
• Evidence suggests statins reduce flares and corticosteroid needs in inflammatory bowel disease, with rare hepatotoxicity and modest myopathy risks.

Conclusions:

• Statins demonstrate potential as repurposed agents in gastroenterology, offering benefits in liver disease and inflammatory bowel disease.
• Definitive randomized trials are essential to establish class effects, optimize dosing, and identify biomarkers for statin therapy in gastrointestinal conditions.