In the Journals

Statin use in HBV-, HCV-related cirrhosis leads to less decompensation

Statin use significantly decreased decompensation in patients with HBV- and HCV-related cirrhosis, with a borderline effect observed in patients with alcoholic cirrhosis, according to recently published study results.

“Improved survival was further noted in statin users of mainly HBV-related cirrhosis. Statin use may also reduce [hepatocellular carcinoma] occurrence among cirrhotic patients,” Fu-Ming Chang, MD, from the division of gastroenterology, Taipei Veterans General Hospital, Taiwan, and colleagues wrote. “Statins may be considered as an adjuvant therapy to prevent decompensation among cirrhotic patients.”

The researchers reviewed the Taiwan National Health Insurance research database between Jan. 1, 2000, and Dec. 31, 2013, for patients with cirrhosis related to HBV, HCV or alcohol-related disease. The study included a statin-user cohort of 675 patients who took more than 28 cumulative defined daily dose (cDDD) and a non-user cohort of 675 patients did not take statins or took less than 28 cDDD. The study used a propensity-score matched design to pair the patients between cohorts.

Overall, patients in the statin-user cohort compared with non-users had a significantly lower rate of decompensation (14% vs. 29%; P < .0001), mortality (9% vs. 18%; P < .0001) and HCC occurrence (6% vs. 10%; P = .0097).

Regarding patients with HBV-related cirrhosis (n = 605), statin users compared with non-users had a significantly lower risk for decompensation (12% vs. 31%; P < .001) and mortality (6% vs. 19%; P < .001), but not HCC occurrence (9% vs. 13%; P = .114).

For patients with HCV-related cirrhosis (n = 298), statin users compared with non-users had significantly lower risk for decompensation (14% vs. 28%; P = .007), but not in mortality rate (12% vs. 20%; P = .063) or HCC occurrence (6% vs. 14%; P = .124).

Of patients with alcohol-related cirrhosis (n = 447), statin users compared with non-users had a significantly lower risk for decompensation (17% vs. 28%; P = .006), but a similar risk for mortality (11% vs. 17%; P = .102) and HCC occurrence (3% vs. 4%; P = .454).

Finally, the statin users had a significantly lower risk for ascites and related complications, hepatic encephalopathy and variceal bleeding compared with the non-users.

“Our results extended the current knowledge and showed statin use can significantly decrease the risk of decompensation of cirrhosis in the general population in a dose-response manner among cirrhotic patients with chronic HBV or HCV infection, and possibly in alcoholic cirrhosis,” the researchers wrote. “After regression adjustment, statin use could borderline reduce the risk of decompensation in patients with alcohol-related cirrhosis. The underlying cause of the observation is unclear, but we suspected continued alcohol consumption or poor statin adherence might contribute to the finding. Abstinence remains the cornerstone of therapy for patients with alcoholic cirrhosis.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.

Statin use significantly decreased decompensation in patients with HBV- and HCV-related cirrhosis, with a borderline effect observed in patients with alcoholic cirrhosis, according to recently published study results.

“Improved survival was further noted in statin users of mainly HBV-related cirrhosis. Statin use may also reduce [hepatocellular carcinoma] occurrence among cirrhotic patients,” Fu-Ming Chang, MD, from the division of gastroenterology, Taipei Veterans General Hospital, Taiwan, and colleagues wrote. “Statins may be considered as an adjuvant therapy to prevent decompensation among cirrhotic patients.”

The researchers reviewed the Taiwan National Health Insurance research database between Jan. 1, 2000, and Dec. 31, 2013, for patients with cirrhosis related to HBV, HCV or alcohol-related disease. The study included a statin-user cohort of 675 patients who took more than 28 cumulative defined daily dose (cDDD) and a non-user cohort of 675 patients did not take statins or took less than 28 cDDD. The study used a propensity-score matched design to pair the patients between cohorts.

Overall, patients in the statin-user cohort compared with non-users had a significantly lower rate of decompensation (14% vs. 29%; P < .0001), mortality (9% vs. 18%; P < .0001) and HCC occurrence (6% vs. 10%; P = .0097).

Regarding patients with HBV-related cirrhosis (n = 605), statin users compared with non-users had a significantly lower risk for decompensation (12% vs. 31%; P < .001) and mortality (6% vs. 19%; P < .001), but not HCC occurrence (9% vs. 13%; P = .114).

For patients with HCV-related cirrhosis (n = 298), statin users compared with non-users had significantly lower risk for decompensation (14% vs. 28%; P = .007), but not in mortality rate (12% vs. 20%; P = .063) or HCC occurrence (6% vs. 14%; P = .124).

Of patients with alcohol-related cirrhosis (n = 447), statin users compared with non-users had a significantly lower risk for decompensation (17% vs. 28%; P = .006), but a similar risk for mortality (11% vs. 17%; P = .102) and HCC occurrence (3% vs. 4%; P = .454).

Finally, the statin users had a significantly lower risk for ascites and related complications, hepatic encephalopathy and variceal bleeding compared with the non-users.

“Our results extended the current knowledge and showed statin use can significantly decrease the risk of decompensation of cirrhosis in the general population in a dose-response manner among cirrhotic patients with chronic HBV or HCV infection, and possibly in alcoholic cirrhosis,” the researchers wrote. “After regression adjustment, statin use could borderline reduce the risk of decompensation in patients with alcohol-related cirrhosis. The underlying cause of the observation is unclear, but we suspected continued alcohol consumption or poor statin adherence might contribute to the finding. Abstinence remains the cornerstone of therapy for patients with alcoholic cirrhosis.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.