Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Oct;15(10):1521-1530.e8.
doi: 10.1016/j.cgh.2017.04.039. Epub 2017 May 4.

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

Rebecca G Kim  1 , Rohit Loomba  2 , Larry J Prokop  3 , Siddharth Singh  4
Affiliations
Meta-Analysis

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

Rebecca G Kim et al. Clin Gastroenterol Hepatol. 2017 Oct.

Abstract

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: Cholesterol-lowering Drug; Cirrhosis; Liver Fibrosis; Meta-analysis; RCT.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None

Figures

Figure 1
Figure 1
Study selection flowsheet
Figure 2
Figure 2
Forest plot showing the association between statin exposure and risk of progression of fibrosis or development of cirrhosis
Figure 3
Figure 3
Forest plot showing the association between statin exposure and risk of decompensation of cirrhosis. Of note, on restricting analysis only to patients with baseline compensated cirrhosis (excluding patients with non-cirrhotic CLDs in Huang et al), a similar protective association of between statin use and risk of hepatic decompensation was observed (RR, 0.54; 95% CI, 0.44–0.66)
Figure 4
Figure 4
Forest plot showing the association between statin exposure and risk of all-cause mortality. On restricting analysis only to patients with baseline cirrhosis (excluding patients with non-cirrhotic CLDs), a similar protective association was observed (RR, 0.54; 95% CI, 0.47–0.61), with minimal heterogeneity (I2=10%).
Figure 5
Figure 5
Forest plot showing the association between statin exposure and risk of progression of portal hypertension
See this image and copyright information in PMC

References

    1. Xu J, Murphy SL, Kochanek KD, et al. Deaths: Final Data for 2013. National Vital Statistics Reports. 2016;64:1–119. - PubMed
    1. Grundy SM. HMG-CoA Reductase Inhibitors for Treatment of Hypercholesterolemia. N Engl J Med. 1988;319:24–33. - PubMed
    1. Endo A, MK, Tanzawa K. Competitive inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase by ML-236A and ML-236B fungal metabolites, having hypocholesterolemic activity. FEBS Lett. 1976;1976:323–326. - PubMed
    1. Tsujita Y, Kuroda M, Tanzawa K, et al. Hypolipidemic effects in dogs of ML-236B, a competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase. Atherosclerosis. 1979;32:307–313. - PubMed
    1. Shigematsu H, Hata Y, Yamamoto M, et al. Treatment of hypercholesterolemia with a HMG CoA reductase inhibitor (CS-500). I. Phase I study in normal subjects. Geriatr Med. 1979;17:1564–1570.

MeSH terms

Substances