Association Between Statins and Chronic Liver Disease Progression: A Retrospective Cohort Study

Statins improve portal hypertension and may reduce mortality in cirrhosis, though their impact on chronic liver disease (CLD) progression before developing advanced fibrosis or cirrhosis remains unclear. We aimed to assess the association of statin use with severe liver disease (SLD) outcomes (cirrhosis or HCC) and fibrosis progression in CLD patients.

We performed a retrospective cohort study of primary care electronic health record data from 2012-2021. Included were patients with CLD, lab inputs for a Fibrosis-4 (FIB-4) calculation and no prior SLD. Analysis 1 assessed the association of statin prescriptions with time to SLD in all patients. Analysis 2 evaluated the association of statin prescriptions with time to high-risk FIB-4 (≥3.25) in patients with baseline FIB-4 <3.25. Unadjusted and adjusted Cox and Weibull regression models were used.

The cohort included 2,872 CLD patients (median index FIB-4 1.2 IQR: 0.7-1.9) followed for a mean of 5.7 (±2.6) years. 884 (31%) patients received statins and 378 (13%) experienced an SLD outcome. Statin prescription was associated with a lower risk of SLD (adjusted HR 0.51; 95% CI 0.39-0.66). Analysis 2 included 2,547 patients with an index FIB-4 <3.25 followed for a mean of 5.4 (±2.6) years. 855 (34%) patients received statins and 600 (24%) progressed to a FIB-4 ≥3.25. Statin prescription was associated with a lower hazard of progressing to high-risk FIB-4 (adjusted HR 0.36; 95% CI 0.32-0.42).

In a primary care population, statin prescriptions were associated with a lower risk of fibrosis progression and SLD.