title: Severe hepatic injury associated with different statins in patients with chronic liver disease: a nationwide population-based cohort study.
abstract: OBJECTIVE
  The hepatotoxicity of statins in patients with chronic liver diseases remains unclear. In this study, we aimed to estimate the risk of severe hepatic injury associated with different statins in patients with chronic liver disease.
  
  
  METHODS
  A nationwide population-based cohort study was conducted by analyzing the Taiwan National Health Insurance database. A total of 37,929 subjects with chronic liver disease who started statin therapy were identified during the period of January 1, 2005 to December 31, 2009. Outcome was defined as hospitalization due to liver injury.
  
  
  RESULTS
  During a total of 118,772 person-years of follow-up, 912 incident cases of hospitalization due to hepatic injury are identified. The incidence rate was 2.95, 2.49, 2.92, 1.94, 2.65, and 2.52 per 100,000 person-days for atorvastatin, lovastatin, fluvastatin, pravastatin, simvastatin, and rosuvastatin initiators, respectively. Overall, there was no difference in the incidence associated with different statins. However, when each statin was further categorized to high (≧ 0.5 defined daily dose) or low (< 0.5 defined daily dose) mean daily dose, only high-dose atorvastatin was significantly associated with increased risk of hospitalization due to hepatic injury (hazard ratio, 1.62; 95% confidence interval, 1.29, 2.03) as compared with low-dose atorvastatin.
  
  
  CONCLUSIONS
  The overall incidence of hospitalization due to severe hepatic injury was low among statin initiators with chronic liver disease. Only high-dose atorvastatin was associated with increased risk.
authors.affiliation: Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chia-Hsuin
authors.initials: CH
authors.lastname: Chang
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Chang
authors.forename: Yen-Chieh
authors.initials: YC
authors.lastname: Lee
authors.forename: Ying-Chun
authors.initials: YC
authors.lastname: Liu
authors.forename: Lee-Ming
authors.initials: LM
authors.lastname: Chuang
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000069059:Atorvastatin; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology*; D002908:Chronic Disease; D015331:Cohort Studies; D005500:Follow-Up Studies; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000009:adverse effects; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects; D012306:Risk; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin
keywords: National Health Insurance; acute hepatic injury; atorvastatin; chronic liver disease; statin