Statin use in patients with cirrhosis: a retrospective cohort study.
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.


OBJECTIVE
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.
Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA, sok9028@med.cornell.edu.
Sonal
S
Kumar
Norman D
ND
Grace
Amir A
AA
Qamar
D000368:Aged; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000201:enzymology / Q000401:mortality*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors