Statins linked to lower risk for cirrhosis in chronic liver diseases
Kim RG, et al. Clin Gastroenterol Hepatol. 2017;doi:10.1016/j.cgh.2017.04.039.
May 16, 2017
Results of a systematic review and meta-analysis showed a probable association between statin use and a lower risk for hepatic decompensation and mortality in patients with chronic liver disease. Further, statin use may reduce portal hypertension in these patients.
“Statins are one class of medications being studied to determine their effect on progression and decompensation of [chronic liver diseases],” Rebecca G. Kim, MD, MS, from the University of California at San Diego, and colleagues wrote. “Epidemiological studies have observed a protective association between statin use and hepatocellular cancer. Recent studies have also suggested an association between statin use and risk of fibrosis progression and hepatic decompensation in patients with [chronic liver diseases], although the effects have been variable.”
To determine the association between statin use and the risk for fibrosis progression or cirrhosis development, risk for developing decompensated cirrhosis, mortality and progression of portal hypertension, researchers reviewed the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database and Systematic Reviews, Scopus, Web of Science and PubMed databases.
Thirteen studies totaling 121,058 patients initially met the researchers’ criteria, including three randomized control trials and 10 observational studies. Two studies were later excluded due to similar population and insufficient information, respectively.
Five studies reported statin use was associated with a 58% lower risk for development of cirrhosis or progression of fibrosis in patients with non-cirrhotic chronic liver diseases (RR = 0.42; 95% CI, 0.16-1.11). Excluding one of these studies that relied solely on administrative claims codes, the researchers found a 35% lower risk (RR = 0.65; 95% CI, 0.48-0.87). Three of these studies reported specifically on the risk for fibrosis progression, resulting in a 27% lower risk (RR = 0.73; 95% CI, 0.54-1).
Four studies reported a 46% lower risk for progression to decompensated cirrhosis in both patients with baseline compensated cirrhosis and non-cirrhotic chronic liver diseases (RR = 0.54; 95% CI, 0.46-0.62). In patients with baseline compensation only, there was a similar protective association between statin use and risk for hepatic decompensation (RR = 0.54; 95% CI, 0.44-0.66).
Six studies reported statin use was associated with a 39% lower risk for mortality (RR = 0.61; 95% CI, 0.48-0.78). Out of four studies that reported on the risk for re-bleeding or clinically significant improvement in portal hypertension in patients with baseline cirrhosis, three randomized control trials reported a 27% lower risk (RR = 0.73; 95% CI, 0.59-0.91) and one observational study reported a 61% lower risk (RR = 0.39; 95% CI, 0.19-0.79).
“Moderate quality evidence suggests beneficial effect of statins on risk of hepatic decompensation and mortality, and variceal bleeding, especially in patients with known compensated cirrhosis, and low quality evidence suggests a mortality benefit in patients with [chronic liver diseases],” the researchers concluded. “Large, pragmatic [randomized control trials] in patients with compensated cirrhosis, are required to confirm these observations.” – by Talitha Bennett
Disclosures: The researchers report no relevant financial disclosures.
作者: StephenW 时间: 2017-5-28 20:49
他汀类药物与慢性肝病肝硬化风险降低有关
Kim RG,et al。胃肠激素肝素2017; DOI:10.1016 / j.cgh.2017.04.039。
2017年5月16日
“他汀类药物是一类正在研究的药物,以确定其对慢性肝脏疾病进展和代偿失调的影响,”加利福尼亚大学圣地亚哥分校的Rebecca G. Kim,医学博士和同事们写道。 “流行病学研究观察到他汀类药物使用与肝细胞癌之间的保护性关联。最近的研究也表明,他汀类药物使用与[慢性肝病]患者纤维化进展与肝功能衰竭的风险有关,尽管效果是可变的。“
为了确定他汀类药物使用与纤维化进展或肝硬化发展风险之间的联系,发展失代偿性肝硬化的风险,门静脉高压的死亡率和进展,研究人员回顾了MEDLINE,EMBASE,Cochrane对照试验中心登记册,Cochrane数据库和系统评价, Scopus,Web of Science和PubMed数据库。