Adults with non-cirrhotic chronic liver disease may reduce their risk of the disease progression to severe stage by 40% if they were taking statins, according to a recent study published online in Clinical Gastroenterology and Hepatology.¹ They were less likely to develop cirrhosis or hepatocellular carcinoma (HCC) and had lower liver-related mortality.

Researchers from UK, USA and Sweden examined the impact of statin use on non-cirrhotic chronic liver diseases using liver histopathology data of 3862 patients from the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) study, which had histopathology record data from the GI tract, liver, gallbladder and pancreas from 1969 to 2017. They were matched 1:1 with 3862 patients with chronic liver diseases who did not use statins. In the total cohort, 45% of patients had nonalcoholic fatty liver disease (NAFLD), 22% had alcohol-related liver disease (ALD), 18% had viral hepatitis and 15% had autoimmune hepatitis.

Analysis of data revealed that chronic liver disease progression to severe liver disease occurred in 6.1% of statin users compared to 7.1% of statin non-users with incidence rates of 10.5 per 1000 person-years vs 18.1 per 1000 person-years. The use of statins was associated with 40% reduction in severe liver disease with hazard ratio (HR) of 0.60. When individual diseases were examined, progression rate was lower in patients with ALD (HR 0.30) and NAFLD (HR 0.68), but not in those with viral hepatitis (HR 0.76) or autoimmune hepatitis (HR 0.88). The use of statins was protective in pre-fibrotic as well as fibrotic stages. Patients who were taking statins were less likely to advance to cirrhosis (HR, 0.62), hepatocellular carcinoma (HR, 0.44), which were the primary outcomes of the study. They also had a lower probability of dying due to liver disease or liver transplantation (HR 0.55).

These findings demonstrate an inverse relationship between statin use and progression to severe liver disease in patients with non-cirrhotic chronic liver disease, especially those with alcohol-related liver disease and non-alcoholic fatty liver disease suggesting “a potential disease modifying role” for statins. However, the researchers also caution that despite the evidence from their study, further prospective randomized controlled trials will be required before statin use for this indication can become a practice recommendation.

References

1. Sharma R, et al. Statins are associated with a decreased risk of severe liver disease in individuals with non-cirrhotic chronic liver disease. Clin Gastroenterol Hepatol. 2023 Apr 28;S1542-3565(23)00317-8. doi: 10.1016/j.cgh.2023.04.017.
2. Statins appear to guard against liver disease progression - Medscape - May 12, 2023.