Carlos Moctezuma-Velázquez1, Juan G Abraldes1, Aldo J Montano-Loza2. 1. Division of Gastroenterology and Liver Unit, University of Alberta, 8540 112 Street NW, Zeidler Ledcor Centre, Room 1-20B, Edmonton, Alberta, T6G 2X8, Canada. 2. Division of Gastroenterology and Liver Unit, University of Alberta, 8540 112 Street NW, Zeidler Ledcor Centre, Room 1-20B, Edmonton, Alberta, T6G 2X8, Canada. aldo.montano-loza@ualberta.ca.
Abstract
PURPOSE OF REVIEW: Statins are drugs developed to treat hypercholesterolemia. Its use in patients with liver disease has been limited because one of its potential and most feared side effects is hepatotoxicity. However, there is robust evidence that supports the safety of statins in this population in the absence of severe liver dysfunction. In this review, we will summarize the efficacy and safety of statins in cirrhosis. RECENT FINDINGS: Statins are effective in the treatment of dyslipidemia in patients with liver disease, because of their pleiotropic properties. These properties are independent of their effect on cholesterol levels, such as improving endothelial dysfunction or having antioxidant, antifibrotic, anti-inflammatory, antiproliferative, antiangiogenic, proapoptotic, or immunomodulation properties. Statins have been studied in other areas such as in treatment of portal hypertension, prevention of hepatocellular carcinoma, and/or protection against ischemia/reperfusion injury. Approved indications for statins in patients with cirrhosis are those of the general population, including dyslipidemia and increased cardiovascular risk. Compensated cirrhosis is not a contraindication. In patients with decompensated cirrhosis, statins should be prescribed with extreme caution at low doses, and with frequent monitoring of creatinine phosphokinase levels in order to detect adverse events in a timely fashion.
PURPOSE OF REVIEW: Statins are drugs developed to treat hypercholesterolemia. Its use in patients with liver disease has been limited because one of its potential and most feared side effects is hepatotoxicity. However, there is robust evidence that supports the safety of statins in this population in the absence of severe liver dysfunction. In this review, we will summarize the efficacy and safety of statins in cirrhosis. RECENT FINDINGS: Statins are effective in the treatment of dyslipidemia in patients with liver disease, because of their pleiotropic properties. These properties are independent of their effect on cholesterol levels, such as improving endothelial dysfunction or having antioxidant, antifibrotic, anti-inflammatory, antiproliferative, antiangiogenic, proapoptotic, or immunomodulation properties. Statins have been studied in other areas such as in treatment of portal hypertension, prevention of hepatocellular carcinoma, and/or protection against ischemia/reperfusion injury. Approved indications for statins in patients with cirrhosis are those of the general population, including dyslipidemia and increased cardiovascular risk. Compensated cirrhosis is not a contraindication. In patients with decompensated cirrhosis, statins should be prescribed with extreme caution at low doses, and with frequent monitoring of creatinine phosphokinase levels in order to detect adverse events in a timely fashion.
Authors: Stephen A Harrison; Lorenzo Rossaro; Ke-Qin Hu; Keyur Patel; Hans Tillmann; Sandeep Dhaliwal; Dawn M Torres; Kenneth Koury; Venkata S Goteti; Stephanie Noviello; Clifford A Brass; Janice K Albrecht; John G McHutchison; Mark S Sulkowski Journal: Hepatology Date: 2010-09 Impact factor: 17.425
Authors: Naga Chalasani; Hisham Aljadhey; Joe Kesterson; Michael D Murray; Stephen D Hall Journal: Gastroenterology Date: 2004-05 Impact factor: 22.682
Authors: Mark W Russo; Jay H Hoofnagle; Jiezhun Gu; Robert J Fontana; Huiman Barnhart; David E Kleiner; Naga Chalasani; Herbert L Bonkovsky Journal: Hepatology Date: 2014-05-13 Impact factor: 17.425
Authors: Juan G Abraldes; Candid Villanueva; Carles Aracil; Juan Turnes; Manuel Hernandez-Guerra; Joan Genesca; Manuel Rodriguez; Jose Castellote; Juan Carlos García-Pagán; Ferran Torres; Jose Luis Calleja; Agustin Albillos; Jaime Bosch Journal: Gastroenterology Date: 2016-01-14 Impact factor: 22.682
Authors: Raquel Maeso-Díaz; Martí Ortega-Ribera; Erica Lafoz; Juan José Lozano; Anna Baiges; Rubén Francés; Agustín Albillos; Carmen Peralta; Juan Carlos García-Pagán; Jaime Bosch; Victoria C Cogger; Jordi Gracia-Sancho Journal: Aging Dis Date: 2019-08-01 Impact factor: 6.745
Authors: Enrica Rossini; Federico Biscetti; Maria Margherita Rando; Elisabetta Nardella; Andrea Leonardo Cecchini; Maria Anna Nicolazzi; Marcello Covino; Antonio Gasbarrini; Massimo Massetti; Andrea Flex Journal: Int J Mol Sci Date: 2022-08-18 Impact factor: 6.208
Authors: David Kockerling; Rooshi Nathwani; Roberta Forlano; Pinelopi Manousou; Benjamin H Mullish; Ameet Dhar Journal: World J Gastroenterol Date: 2019-02-28 Impact factor: 5.742