title: Statin use is not associated with liver related mortality.
abstract: BACKGROUND AND AIM. Statins are commonly used medications for the treatment of dyslipidemia. Although there are reported cases of hepatotoxicity related to statins, very few are associated with severe course and liver failure. MATERIAL AND METHODS. We used the Third National Health and Nutrition Examination Survey (NHANES III)-mortality linked files to assess the association between statin use and liver-related mortality. Patients with established causes of liver disease (HCV RNA-positive, HBs-Ag-positive, NAFLD by hepatic ultrasound, iron overload and excessive alcohol use of > 20 g of alcohol per day with elevated liver enzymes) were excluded. RESULTS. Of all adult NHANES III participants enrolled in 1988-1994 (n = 20,050), 9,207 individuals had sufficient demographic, clinical and medical information making them eligible for this study (age 41.26 ± 0.38, 46.76% male, 76.67% Caucasian, BMI 26.39 ± 0.38, 16.99% had diabetes or insulin resistance, 16.97% had hypertension, 65.28% had dyslipidemia). Of the entire study cohort, 90 (1.25%) participants reported using statins at the time of the interview. Median mortality follow-up for the study cohort was 175.54 months. During this period, 1,330 individuals (11.25%) died with 26 (0.17%) being liver-related deaths. For the cohort using statins, there were 37 deaths (40.15%) after a median follow-up of 143.35 months. In fact, the top cause of death for statin users was cardiac related (16 cases, 33.62%). However, after adjusting for major demographic, clinical and metabolic confounders, statin use was not associated with cardiovascular deaths in males (Hazard Ratio, 0.79, 95% Confidence Interval, 0.30-2.13), but was associated with higher risk of cardiovascular deaths in females (odds ratio, 2.32, 95% confidence interval, 1.58-3.40). Furthermore, the rate of liver-related mortality was significantly lower (p = 0.0035) among statin users compared to non-statin users. CONCLUSIONS. After a decade of follow up, there was no association between statin use and liver-related mortality.
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Younoszai
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Li
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States.
authors.forename: Maria
authors.initials: M
authors.lastname: Stepanova
authors.affiliation: Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, United States.
authors.forename: Madeline
authors.initials: M
authors.lastname: Erario
authors.affiliation: Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, United States.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cable
authors.affiliation: Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, United States.
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy*; D008107:Liver Diseases / Q000150:complications / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D016016:Proportional Hazards Models; D055815:Young Adult
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors