Statins reduce risk of decompensation for people with HCV- and HBV-related cirrhosis

Treatment with statins reduces the risk of decompensated liver disease for people with cirrhosis caused by hepatitis B virus (HBV) and hepatitis C virus (HCV), investigators from Taiwan report in the online edition of Hepatology. The treatment also modestly reduced the risk of decompensated disease for people with alcohol-related cirrhosis.

“We identified that statin use may lower risk of decompensation in a dose-response manner by around 50-60% among cirrhotic patients with chronic HBV or HCV infection, while borderline effect was noted in alcoholic cirrhosis,” write the researchers. “The benefit provided by statin use was mainly in decreasing the risk of ascites-related complications and hepatic encephalopathy.”

Cirrhosis of the liver can be caused by HBV, HCV or alcohol abuse. Decompensated cirrhosis is associated with a poor prognosis. To avoid progression to decompensated disease, early therapy is strongly advocated.

One such therapy is statins. Research involving US veterans showed that statins were beneficial for people with HCV-related cirrhosis, whereas research conducted in Taiwan revealed that the therapy reduced the risk of decompensation for people with HBV-related cirrhosis. However, this research had several limitations, including small sample size or restricted patient population. The benefits of statins for people with alcohol-related cirrhosis remains unclear, and it is also unknown if statins reduce the risk of hepatocellular carcinoma (HCC) and mortality in people with cirrhosis.

To establish a clearer understanding of the benefits of statins for people with cirrhosis due to multiple causes, investigators from Taiwan used their country’s national health research database to see if the therapy reduced the risk of decompensation, mortality and HCC occurrence among people with cirrhosis caused by HBV, HCV and alcohol.

Adults diagnosed with cirrhosis were eligible for inclusion. Statin use was defined as daily therapy for at least 28 days. The case controlled study enrolled 675 people who were treated with statins and 675 people who did not take this therapy. Individuals received care between 2000 and 2013.

Overall results showed benefits of statin therapy. Compared with non-users, individuals prescribed statins had significantly lower rates of decompensation (14% vs 29%; p < 0.0001), mortality (9% vs 18%; p < 0.0001) and occurrence of HCC (6% vs 10%; p = 0.0097). The overall benefit of statins was confirmed in multivariate analysis that controlled for potential confounders, with statins associated with a significantly lower risk of decompensation (aHR = 0.39; 95% CI, 0.30-0.50), mortality (aHR = 0.46; 95% CI, 0.34-0.63) and liver cancer (aHR = 0.52; 95% CI, 0.35-0.76).

There was a dose-related response, with the benefits of statin therapy increasing with longer duration of treatment.

Analysis of individuals with HBV-related cirrhosis revealed that, compared to non-users, statin users had a significantly lower risk of decompensation (12% vs 31%; p < 0.001) and mortality (6% vs 19%; p < 0.001) but not HCC occurrence (9% vs 13%). Multivariate analysis confirmed that statin therapy reduced risk of both decompensation (aHR = 0.39; 95% CI, 0.26-0.62) and mortality (aHR = 0.39; 95% CI, 0.21-0.72) but not liver cancer (aHR = 0.70; 95% CI, 0.40-1.25).

Analysis then turned to people with HCV-related cirrhosis. Statin users had a significantly lower rate of decompensation (14% vs 28%; p = 0.007), but not mortality (12% vs 20%) or HCC occurrence (6% vs 14%). The reduced risk of decompensation was confirmed in the multivariate analysis (aHR = 0.51; 95% CI, 0.29-0.93), which also showed that use of statins did not significantly reduce the risk of mortality but had a borderline effect on occurrence of liver cancer (aHR = 0.38; 95% CI, 0.14-1.04).

Investigators then examined the benefits of statins for people with alcohol-related liver disease. Statin users had a significantly lower rate of decompensation (17% vs 28%) but the mortality rate (11% vs 17%) and HCC occurrence rate (35 vs 4%) was similar to that observed in non-statin users. Multivariate analysis showed that statin therapy was associated with a trend for a lower risk of decompensation (aHR = 0.69; 95% CI, 0.45-1.07) but had no benefit in terms of mortality or progression to HCC.

Statins lowered the risk of ascites and related complications, hepatic encephalopathy and variceal bleeding.

“Statin use decreased the decompensation rate in HBV- and HCV-related cirrhosis, while borderline effect was noted in alcoholic cirrhosis,” conclude the authors. “Statins may be considered as an adjuvant therapy to prevent decompensation among cirrhotic patients. Future prospective studies are needed to confirm our findings.”