Guideline-conform statin use reduces overall mortality in patients with compensated liver disease

Sci Rep. 2019 Aug 12;9(1):11674. doi: 10.1038/s41598-019-47943-6.

Abstract

Statins reduce cardiovascular risk. However, "real-life" data on statin use in patients with chronic liver disease and its impact on overall and liver-related survival are limited. Therefore, we assessed 1265 CLD patients stratified as advanced (ACLD) or non-advanced (non-ACLD) stage. Statin indication was evaluated according to the 2013 ACC/AHA guidelines and survival-status was verified by national death registry data. Overall, 122 (9.6%) patients had an indication for statin therapy but did not receive statins, 178 (14.1%) patients were on statins and 965 (76.3%) patients had no indication for statins. Statin underutilization was 34.2% in non-ACLD and 48.2% in ACLD patients. In non-ACLD patients, survival was worse without a statin despite indication as compared to patients on statin or without indication (log-rank p = 0.018). In ACLD patients, statin use did not significantly impact on survival (log-rank p = 0.264). Multivariate cox regression analysis confirmed improved overall survival in patients with statin as compared to patients with indication but no statin (HR 0.225; 95%CI 0.053-0.959; p = 0.044) and a trend towards reduced liver-related mortality (HR 0.088; 95%CI 0.006-1.200; p = 0.068). This was not observed in ACLD patients. In conclusion, guideline-confirm statin use is often withhold from patients with liver disease and this underutilization is associated with impaired survival in non-ACLD patients.

MeSH terms

  • Adult
  • Aged
  • Anticholesteremic Agents / therapeutic use*
  • Chronic Disease
  • Dyslipidemias / drug therapy*
  • Dyslipidemias / metabolism
  • Dyslipidemias / mortality
  • Dyslipidemias / pathology
  • Female
  • Hepatic Insufficiency / drug therapy*
  • Hepatic Insufficiency / metabolism
  • Hepatic Insufficiency / mortality
  • Hepatic Insufficiency / pathology
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Liver / drug effects
  • Liver / metabolism
  • Liver / pathology
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Proportional Hazards Models
  • Registries

Substances

  • Anticholesteremic Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors