Sonal Kumar1, Norman D Grace, Amir A Qamar. 1. Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA, sok9028@med.cornell.edu.
Abstract
BACKGROUND: Statins reduce cardiovascular risk. Patients with cirrhosis have decreased hepatic clearance of statins and potentially increased risk for complications. No studies assess mortality in patients with biopsy-confirmed cirrhosis. AIM: Compare mortality in patients with cirrhosis on statins to those not on statins. METHODS: A retrospective cohort study evaluated patients from 1988 to 2011 at Partners Healthcare Hospitals. The Partners Research Patient Data Registry identified patients with biopsy-proven cirrhosis on statins at biopsy and at least 3 months following. Controls were matched 1:2 by age, gender and Child-Pugh class. Decompensation was defined as ascites, jaundice/bilirubin >2.5 mg/dL, and/or hepatic encephalopathy or variceal hemorrhage. Primary outcome was mortality. Secondary outcome was decompensation in baseline-compensated patients. Chi-square and two-way ANOVA testing compared groups. Cox proportional hazards models for mortality controlled for age, Child-Pugh class, diabetes, coronary artery disease, non-alcoholic steatohepatitis and hepatocellular carcinoma. Kaplan-Meier curves graphed mortality. RESULTS: Eighty-one statin users and 162 controls were included. Median follow-up: 36 months in statin users and 30 months in controls. 70.4% of patients were Child-Pugh A. Model for End-Stage Liver Disease (MELD), albumin, varices and beta-blocker use were not significantly different between groups. Statin users had lower mortality on multivariate analysis (HR 0.53, p = 0.01), and Child-Pugh A patients had longer survival on Kaplan-Meier analysis. Cox multivariate analysis for decompensation showed lower risk of decompensation with statins while increased decompensation with low albumin, high MELD score and beta-blocker use. CONCLUSIONS: In patients with cirrhosis, statin therapy is not associated with increased mortality and may delay decompensation.
BACKGROUND: Statins reduce cardiovascular risk. Patients with cirrhosis have decreased hepatic clearance of statins and potentially increased risk for complications. No studies assess mortality in patients with biopsy-confirmed cirrhosis. AIM: Compare mortality in patients with cirrhosis on statins to those not on statins. METHODS: A retrospective cohort study evaluated patients from 1988 to 2011 at Partners Healthcare Hospitals. The Partners Research Patient Data Registry identified patients with biopsy-proven cirrhosis on statins at biopsy and at least 3 months following. Controls were matched 1:2 by age, gender and Child-Pugh class. Decompensation was defined as ascites, jaundice/bilirubin >2.5 mg/dL, and/or hepatic encephalopathy or variceal hemorrhage. Primary outcome was mortality. Secondary outcome was decompensation in baseline-compensated patients. Chi-square and two-way ANOVA testing compared groups. Cox proportional hazards models for mortality controlled for age, Child-Pugh class, diabetes, coronary artery disease, non-alcoholic steatohepatitis and hepatocellular carcinoma. Kaplan-Meier curves graphed mortality. RESULTS: Eighty-one statin users and 162 controls were included. Median follow-up: 36 months in statin users and 30 months in controls. 70.4% of patients were Child-Pugh A. Model for End-Stage Liver Disease (MELD), albumin, varices and beta-blocker use were not significantly different between groups. Statin users had lower mortality on multivariate analysis (HR 0.53, p = 0.01), and Child-Pugh A patients had longer survival on Kaplan-Meier analysis. Cox multivariate analysis for decompensation showed lower risk of decompensation with statins while increased decompensation with low albumin, high MELD score and beta-blocker use. CONCLUSIONS: In patients with cirrhosis, statin therapy is not associated with increased mortality and may delay decompensation.
Authors: Franz Wiesbauer; Georg Heinze; Christa Mitterbauer; Franz Harnoncourt; Walter H Hörl; Rainer Oberbauer Journal: J Am Soc Nephrol Date: 2008-07-23 Impact factor: 10.121
Authors: Naga Chalasani; Hisham Aljadhey; Joe Kesterson; Michael D Murray; Stephen D Hall Journal: Gastroenterology Date: 2004-05 Impact factor: 22.682
Authors: Sehrish Kamal; Muhammad Ali Khan; Ankur Seth; George Cholankeril; Deepansh Gupta; Utkarsh Singh; Faisal Kamal; Colin W Howden; Christopher Stave; Satheesh Nair; Sanjaya K Satapathy; Aijaz Ahmed Journal: Am J Gastroenterol Date: 2017-06-06 Impact factor: 10.864
Authors: Martin Janicko; Sylvia Drazilova; Daniel Pella; Jan Fedacko; Peter Jarcuska Journal: World J Gastroenterol Date: 2016-07-21 Impact factor: 5.742