Format

Send to

Choose Destination
Gastroenterology. 2019 May;156(6):1693-1706.e12. doi: 10.1053/j.gastro.2019.01.026. Epub 2019 Jan 18.

Effects of Hypercholesterolemia and Statin Exposure on Survival in a Large National Cohort of Patients With Cirrhosis.

Author information

1
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Division of Gastroenterology and Hepatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: dakaplan@pennmedicine.upenn.edu.
2
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Division of Gastroenterology and Hepatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
3
VA Connecticut Healthcare System, West Haven, Connecticut.
4
San Francisco VA Medical Center, San Francisco, California.
5
Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.
6
VA New York Harbor Health Care System, Brooklyn, New York.
7
Boston VA Healthcare System, Boston, Massachusetts.
8
James J. Peters VA Medical Center, Bronx, New York.
9
Minneapolis VA Medical Center, Minneapolis, Minnesota.

Abstract

BACKGROUND & AIMS:

Concerns related to hepatotoxicity frequently lead to discontinuation or non-initiation of 3-hydroxy-3-methylglutaryl-coenzyme A reductase therapy in patients with cirrhosis despite data supporting statin use. We investigated the independent effects of hyperlipidemia and statin exposure on mortality, hepatic decompensation, and hepatocellular carcinoma development in a large national cohort of patients with cirrhosis.

METHODS:

We performed a retrospective cohort study of patients with newly diagnosed cirrhosis from January 1, 2008 through June 30, 2016 in the Veterans Health Administration. Subjects were divided into 2 cohorts: 21,921 patients with prior statin exposure (existing users) and 51,023 statin-naïve individuals, of whom 8794 subsequently initiated statin therapy (new initiators) and 44,269 did not (non-initiators). Multivariable Cox proportional hazard models with inverse probability weighting were constructed to assess the effects of time-updating lipid profiles and cumulative exposure to statins on survival and hepatic decompensation. Statin-naïve new initiators were propensity matched with non-initiators to simulate a randomized controlled trial of statin use in cirrhosis.

RESULTS:

In statin-naïve subjects, every 10-mg/dL increase in baseline total cholesterol was associated with a 3.6% decrease in mortality. In existing users, each year of continued statin exposure was associated with a hazard ratio of 0.920 (95% confidence interval 0.0.897-0.943) for mortality. After risk-set matching, each year of statin exposure among new initiators was associated with a hazard ratio of 0.913 (95% confidence interval 0.890-0.937) for mortality.

CONCLUSIONS:

In a retrospective cohort study of veterans with a new diagnosis of cirrhosis, we associated hypercholesterolemia with well-preserved hepatic function and decreased mortality. Nonetheless, each cumulative year of statin exposure was associated with an independent 8.0%-8.7% decrease of mortality of patients with cirrhosis of Child-Turcotte-Pugh classes A and B.

KEYWORDS:

Alcohol; Fatty Liver; Hepatitis; Nonalcoholic Steatohepatitis

PMID:
30660733
DOI:
10.1053/j.gastro.2019.01.026
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center