Statin Use and Risk of Cirrhosis and Related Complications in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis

  • Rebecca G. Kim
    Affiliations
    Division of Internal Medicine, Department of Medicine, University of California at San Diego, La Jolla, California
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  • Rohit Loomba
    Affiliations
    Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, California

    NAFLD Research Center, Department of Medicine, University of California at San Diego, La Jolla, California

    Division of Epidemiology, Department of Family Medicine and Public Health, University of California at San Diego, La Jolla, California
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  • Larry J. Prokop
    Affiliations
    Department of Library Services, Mayo Clinic, Rochester, Minnesota
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  • Siddharth Singh
    Correspondence
    Reprint requests Address requests for reprints to: Siddharth Singh, MD, MS, Division of Gastroenterology, University of California San Diego, 9452 Medical Center Drive, ACTRI 1W 501, La Jolla, California 92093. fax: 858-657-7259.
    Affiliations
    Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, California

    Division of Biomedical Informatics, Department of Medicine, University of California at San Diego, La Jolla, California
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      Background & Aims

      Statins have been variably shown to decrease risk and complications of chronic liver diseases (CLDs). We performed a systematic review and meta-analysis to evaluate the association between statins and risk of cirrhosis and related complications in patients with CLDs.

      Methods

      Through a systematic literature search up to March 2017, we identified 13 studies (3 randomized trials, 10 cohort studies) in adults with CLDs, reporting the association between statin use and risk of development of cirrhosis, decompensated cirrhosis, improvements in portal hypertension, or mortality. Pooled relative risk (RR) estimates with 95% confidence interval (CIs) were calculated using random effects model. Grading of Recommendations Assessment, Development and Evaluation criteria were used to assess quality of evidence.

      Results

      Among 121,058 patients with CLDs (84.5% with hepatitis C), 46% were exposed to statins. In patients with cirrhosis, statin use was associated with 46% lower risk of hepatic decompensation (4 studies; RR, 0.54; 95% CI, 0.46–0.62; I2 = 0%; moderate-quality evidence), and 46% lower mortality (5 studies; RR, 0.54; 95% CI, 0.47–0.61; I2 = 10%; moderate-quality evidence). In patients with CLD without cirrhosis, statin use was associated with a nonsignificant (58% lower) risk of development of cirrhosis or fibrosis progression (5 studies; RR, 0.42; 95% CI, 0.16–1.11; I2 = 99%; very-low-quality evidence). In 3 randomized controlled trials, statin use was associated with 27% lower risk of variceal bleeding or progression of portal hypertension (hazard ratio, 0.73; 95% CI, 0.59–0.91; I2 = 0%; moderate-quality evidence).

      Conclusions

      Based on a systematic review and meta-analysis, statin use is probably associated with lower risk of hepatic decompensation and mortality, and might reduce portal hypertension, in patients with CLDs. Prospective observational studies and randomized controlled trials are needed to confirm this observation.

      Keywords

      Abbreviations used in this paper:

      CI (confidence interval), CLD (chronic liver disease), GRADE (Grading of Recommendations Assessment, Development and Evaluation), HBV (hepatitis B virus), HCV (hepatitis C virus), RCT (randomized controlled trials), RR (relative risk)
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