Statins underused in NAFLD patients with clear indications
Only 56% of patients with nonalcoholic fatty liver disease were taking guidelines-recommended statin therapy, according to a study published in Clinical Gastroenterology and Hepatology.
“Despite strong safety data supporting their use, statins are under prescribed among patients with liver disease due to concerns about hepatotoxicity,” Mary J. Thomson, MD, from the division of gastroenterology, hepatology and nutrition, University of Minnesota, told Healio Gastroenterology. “Real-world evidence like this study helps flag patterns for providers who can rethink how they’re treating their patients at higher risk for cardiovascular disease.”
Thomson and colleagues’ analysis included 2,214 patients with at least one statin indication who are enrolled in the ongoing TARGET-NASH study. Median age was 62 years. Investigators reviewed medical records available within 3 years before the enrollment for comorbidities and liver disease severity and statin use within 6 months of enrollment. Based on clinical assessments previously described, patients were classified as having nonalcoholic fatty liver, nonalcoholic steatohepatitis, or compensated or decompensated NAFLD cirrhosis.
Researchers used unadjusted and adjusted logistic regression models to evaluate correlations between patient demographics and clinical characteristics with statin use.
Investigators noted that at enrollment 26.2% of patients had compensated cirrhosis, 20.1% had decompensated cirrhosis, 73.2% had hypertension, 83.2% had type 2 diabetes and 62.6% had dyslipidemia.
“Diabetes plus age 40 to 75 years was the most common indication for statin use (81.4%),” Thomson and colleagues wrote. “Overall, 55.8% of patients with at least 1 indication used a statin, with the highest use among patients with clinical ASCVD (63%).”
Patients taking an indicated statin were older (63 years vs. 61 years; P < .0001) and that these patients had more cardiovascular comorbidities and were less often women (58.9% vs. 63.8%; P < .019), according to the study data.
The proportion of patients who received a statin was lower among patients with advanced liver disease, including 60.8% in patients with NAFLD, 61.6% with NASH, 55.1% with compensated cirrhosis and 42.2% with decompensated cirrhosis.
“In a multivariable analysis adjusting for demographics, liver disease severity, and other clinical characteristics, [age 65 years or older] (odds ratio [OR] = 1.44; 95% CI, 1.11–1.88), no cirrhosis vs. decompensated cirrhosis (OR = 1.88; 95% CI 1.34–2.65), compensated vs. decompensated cirrhosis (OR = 1.44; 95% CI, 1.04–1.99), history of hypertension (OR = 1.32; 95% CI, 1.03–1.69), type 2 diabetes (OR = 1.96; 95% CI, 1.44–2.67), dyslipidemia (OR = 5.42; 95% CI, 4.34–6.77), and clinical ASCVD (OR = 1.49; 95% CI, 1.16–1.92) were independently associated with higher odds of statin use,” Thomson and colleagues wrote.
The researchers also said there was a trend toward higher statin use in those without cirrhosis vs. those with compensated cirrhosis (OR = 1.31; 95% CI, 1–1.72). Additionally, female sex (OR = 0.7; 95% CI, 0.56–0.88) and platelet count less than 100,000/L (OR = 0.7; 95% CI, 0.5–0.97) correlated with lower odds of statin use.