In the Journals

Review shows benefits of statin use in patients with chronic liver injury

Statins were cost-effective and generally well-tolerated, and their benefits often outweighed their potential hepatotoxic risk in patients with severe chronic liver injury and a high risk for developing cardiovascular diseases, according to a recent review of statin studies.

“Statin drugs are widely used to manage high cholesterol and reduce the risk of cardiovascular disease. But in a new review of more than 50 studies, researchers cite reduction in liver inflammation and improvements in other related factors as reasons why statins make good candidates for treating chronic liver disease,” according to a press release.

In studies analyzing the efficacy of statins in patients with cardiovascular diseases, statins improved inflammation, decreased interleukin-6 levels, exerted anti-inflammatory properties in endothelial cells, inhibited the expression of major histocompatibility complex class II molecules and increased the number of circulating endothelial progenitor cells.

The researchers advised caution due to the potential for hepatotoxicity. However, they observed contradictory results regarding the effect of statins on aminotransferase levels. In some cases, statin-induced liver injury was often reported, especially regarding Lipitor (atorvastatin, Pfizer) and Zocor (simvastatin, Merck), but one retrospective cohort study of 93,106 patients with liver disease who were treated with Mevacor (lovastatin, Merck) showed no increased risk for adverse hepatic effects. Additionally, a prospective study showed that alanine aminotransferase levels were even lower in patients treated with Pravachol (pravastatin, Bristol-Myers Squibb), compared with the retrospective study of Mevacor.

“In most cases, the benefits of statins outweigh any potential hepatotoxic risks,” the researchers wrote. “Thus, comparing benefits and risks of statin treatment individually could help improve its efficacy.”

The researchers found that while studies assessing the beneficial effects of statins are scarce with small patient numbers and different endpoints, the studies showed that statin therapy either attenuated inflammation and steatosis or resulted in no change in fibrosis. The studies used different statins, however, with different dosing, making comparisons difficult. Similarly, the differing study outcomes may be related to the lack of genetic screenings. A large multi-center study revealed that statin use was beneficial in high risk patients, except for those with the PNPLA3 I148M allele.

“Another recent study confirmed the beneficial effects of statins, even in patients identified as non-responder to non-selective beta-blockers. Besides decreased portal pressure, cirrhotic patients under statins may also benefit from improved liver function. Interestingly, statin effects are enhanced with increased severity of portal hypertension,” the researchers wrote. “Moreover, the toxicity of statins was less observed as a liver damage, but mainly as myopathy, which might be prevented and attenuated by novel statin drugs, as suggested by using a compound containing atorvastatin and a [nitric-oxide]-donor.”

Overall, the researchers suggested that statin treatment benefits are promising for patients with severe liver injury and high risk for cardiovascular diseases and can also help to prevent the progression of liver fibrosis to cirrhosis and hepatocellular carcinoma. – by Talitha Bennett

Disclosure: Healio.com/Hepatology was unable to determine the financial disclosures at time of publication.

Statins were cost-effective and generally well-tolerated, and their benefits often outweighed their potential hepatotoxic risk in patients with severe chronic liver injury and a high risk for developing cardiovascular diseases, according to a recent review of statin studies.

“Statin drugs are widely used to manage high cholesterol and reduce the risk of cardiovascular disease. But in a new review of more than 50 studies, researchers cite reduction in liver inflammation and improvements in other related factors as reasons why statins make good candidates for treating chronic liver disease,” according to a press release.

In studies analyzing the efficacy of statins in patients with cardiovascular diseases, statins improved inflammation, decreased interleukin-6 levels, exerted anti-inflammatory properties in endothelial cells, inhibited the expression of major histocompatibility complex class II molecules and increased the number of circulating endothelial progenitor cells.

The researchers advised caution due to the potential for hepatotoxicity. However, they observed contradictory results regarding the effect of statins on aminotransferase levels. In some cases, statin-induced liver injury was often reported, especially regarding Lipitor (atorvastatin, Pfizer) and Zocor (simvastatin, Merck), but one retrospective cohort study of 93,106 patients with liver disease who were treated with Mevacor (lovastatin, Merck) showed no increased risk for adverse hepatic effects. Additionally, a prospective study showed that alanine aminotransferase levels were even lower in patients treated with Pravachol (pravastatin, Bristol-Myers Squibb), compared with the retrospective study of Mevacor.

“In most cases, the benefits of statins outweigh any potential hepatotoxic risks,” the researchers wrote. “Thus, comparing benefits and risks of statin treatment individually could help improve its efficacy.”

The researchers found that while studies assessing the beneficial effects of statins are scarce with small patient numbers and different endpoints, the studies showed that statin therapy either attenuated inflammation and steatosis or resulted in no change in fibrosis. The studies used different statins, however, with different dosing, making comparisons difficult. Similarly, the differing study outcomes may be related to the lack of genetic screenings. A large multi-center study revealed that statin use was beneficial in high risk patients, except for those with the PNPLA3 I148M allele.

“Another recent study confirmed the beneficial effects of statins, even in patients identified as non-responder to non-selective beta-blockers. Besides decreased portal pressure, cirrhotic patients under statins may also benefit from improved liver function. Interestingly, statin effects are enhanced with increased severity of portal hypertension,” the researchers wrote. “Moreover, the toxicity of statins was less observed as a liver damage, but mainly as myopathy, which might be prevented and attenuated by novel statin drugs, as suggested by using a compound containing atorvastatin and a [nitric-oxide]-donor.”

Overall, the researchers suggested that statin treatment benefits are promising for patients with severe liver injury and high risk for cardiovascular diseases and can also help to prevent the progression of liver fibrosis to cirrhosis and hepatocellular carcinoma. – by Talitha Bennett

Disclosure: Healio.com/Hepatology was unable to determine the financial disclosures at time of publication.