Statin Utilization Among Individuals Infected With Hepatitis C Virus: A Retrospective Cohort Study

Abstract

Introduction and Objectives Statin use for primary prevention of coronary artery disease (CAD) has historically been limited in patients with chronic liver disease due to concerns for increased adverse events with statin use in this population. We aimed to quantify the underutilization of statins among individuals with a history of HCV infection in a community health system to understand the clinical implications of statin underutilization in a diverse, generalizable population of patients infected with HCV. Materials and Methods We performed a single-center retrospective study of individuals with a history of HCV infection aged 40-75 years from 2019-2021. Statin eligibility was determined using the 2019 American College of Cardiology/American Heart Association (ACC/AHA) guidelines with the 2013 Pooled Cohort Equation used to determine atherosclerotic cardiovascular disease (ASCVD) risk. Baseline characteristics and adverse events of statin and non-statin users were compared, and factors associated with statin use were determined using multivariable logistical regression. Results Based on 2019 ACC/AHA guidelines, 752/1,077 (69.8%) subjects had an indication for a statin, 280/752 (37.2%) of which were treated with a statin. Cirrhosis was independently associated with statin underutilization. Diabetes, anti-hypertensive use, and Black race were all independently associated with statin use in subjects with an indication for therapy. Statin use was not associated with adverse events. Conclusions Statins were underutilized and well tolerated in the cohort of individuals with a history of HCV infection. This high-risk population would benefit from increased CAD screening and utilization of statins for the primary prevention of CAD.

Keywords: cirrhosis; coronary artery disease; hepatitis c virus; primary prevention; statins.

Figure 1. Statin utilization by 2019 American College of Cardiology/American Heart Association guideline-based indication for primary prevention of cardiovascular disease in the cohort of individuals with a history of hepatitis C virus infection.

ASCVD: Atherosclerotic cardiovascular disease.

Figure 2. Multivariable logistic regression model demonstrating predictors of utilization in individuals with an indication for statin therapy.

CI: Confidence interval; OR: Odds ratio. *p < 0.05, **p < 0.001.