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-naive 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-naive new initiators were propensity matched with non-initiators to simulate a randomized controlled trial of statin use in cirrhosis. Results In statin-naive 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.
Liver fibrosis is a common response to many chronic liver diseases. The aim of our study was to explore whether pharmacotherapy for concurrent diseases affects overall mortality, liver-related mortality and liver-related morbidity in patients with chronic liver disease. We performed a register-based cohort study of all patients with a first-time diagnosis of chronic liver disease between 2005 and 2012 in Sweden (n=70 546). Data from the Patient Register, the Prescribed Drug Register and the Deat...
#1Rebecca G. Kim(UCSD: University of California, San Diego)H-Index: 3
#2Rohit Loomba(UCSD: University of California, San Diego)H-Index: 91
Last. Siddharth Singh(UCSD: University of California, San Diego)H-Index: 67
view all 4 authors...
Background & Aims Statins have been variably shown to decrease risk and complications of chronic liver diseases (CLDs). We performed a systematic review and meta-analysis to evaluate the association between statins and risk of cirrhosis and related complications in patients with CLDs. Methods Through a systematic literature search up to March 2017, we identified 13 studies (3 randomized trials, 10 cohort studies) in adults with CLDs, reporting the association between statin use and risk of devel...
Last. Ching-Liang Lu(NYMU: National Yang-Ming University)H-Index: 35
view all 7 authors...
Statin use decreases the risk of decompensation and mortality in patients with cirrhosis due to hepatitis C virus (HCV). Whether this beneficial effect can be extended to cirrhosis in the general population or cirrhosis due to other causes, such as hepatitis B virus (HBV) infection or alcohol, remains unknown. Statin use also decreases the risk of hepatocellular carcinoma (HCC) in patients with chronic HBV and HCV infection. It is unclear whether the effect can be observed in patients with pre-e...
Background Research using the Veterans Health Administration (VA) electronic medical records (EMR) has been limited by a lack of reliable smoking data.
Last. David E. Kaplan(HUP: Hospital of the University of Pennsylvania)H-Index: 71
view all 12 authors...
Background & Aims Little is known about provider and health system factors that affect receipt of active therapy and outcomes of patients with hepatocellular carcinoma (HCC). We investigated patient, provider, and health system factors associated with receipt of active HCC therapy and overall survival. Methods We performed a national, retrospective cohort study of all patients diagnosed with HCC from January 1, 2008 through December 31, 2010 (n = 3988) and followed through December 31 2014 who r...
#1Pierre Blais(BCM: Baylor College of Medicine)H-Index: 2
#2Michael Lin(BCM: Baylor College of Medicine)H-Index: 2
Last. Fasiha Kanwal(BCM: Baylor College of Medicine)H-Index: 61
view all 5 authors...
Background Cardiovascular disease provides the greatest mortality risk in patients with nonalcoholic fatty liver disease (NAFLD). Clinical practice guidelines recommend statins to treat dyslipidemia in patients with NAFLD; however, the extent to which such patients receive statins has not been studied.
#2Mike K. Palmer(MMU: Manchester Metropolitan University)H-Index: 23
Last. Philip J. Barter(UNSW: University of New South Wales)H-Index: 108
view all 5 authors...
Elevated triglyceride (TG) levels are associated with increased cardiovascular disease risk. In patients with mild-to-moderate hypertriglyceridemia, defined by the European Atherosclerosis Society Consensus Panel as a TG level of 177 to 885 mg/dl (2.0 to 10.0 mmol/L), low-density lipoprotein cholesterol (LDL-C) reduction remains the primary treatment goal. Using data from the indiVidual patient meta-analysis Of statin therapY in At risk Groups: Effects of Rosuvastatin, atorvastatin and simvastat...
Background & Aims The combination of β-blockers and band ligation is the standard approach to prevent variceal rebleeding, but bleeding recurs and mortality is high. The lipid-lowering drug simvastatin decreases portal pressure, improves hepatocellular function, and might reduce liver fibrosis. We assessed whether adding simvastatin to standard therapy could reduce rebleeding and death after variceal bleeding in patients with cirrhosis. Methods We performed a multicenter, double-blind, parallel ...
Background null Little is known about use of specialty care among patients admitted with cirrhosis complications. null Aims null We sought to characterize the use and impact of gastroenterology/hepatology (GI/HEP) consultations in hospitalized patients with cirrhosis. We studied two national cohorts-the Veterans Affairs Costs and Outcomes in Liver Disease (VOCAL) and a nationally representative database of commercially insured patients (Optum Clinformatics™ DataMart). null Methods null Cirrhosis...
#1Fasiha Kanwal(BCM: Baylor College of Medicine)H-Index: 61
#2Jay H. Shubrook(College of Osteopathic Medicine of the Pacific)H-Index: 1
Last. Samuel Klein(WashU: Washington University in St. Louis)H-Index: 9
view all 14 authors...
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are common conditions with a rising burden. Yet there are significant management gaps between clinical guidelines and practice in patients with NAFLD and NASH. Further, there is no single global guiding strategy for the management of NAFLD and NASH. The American Gastroenterological Association, in collaboration with 7 professional associations, convened an international conference comprising 32 experts in gastroente...
#1Jihane N. Benhammou(UCLA: University of California, Los Angeles)H-Index: 11
#2Andrew M. Moon(UNC: University of North Carolina at Chapel Hill)H-Index: 13
Last. George N. Ioannou(UNC: University of North Carolina at Chapel Hill)H-Index: 2
view all 7 authors...
In hepatitis C (HCV) patients, obesity and/or diabetes may increase the risk of liver-related outcomes. We aimed to determine whether diabetes and/or obesity are associated with adverse outcomes in direct-acting antiviral (DAA)-treated HCV patients. We conducted a retrospective study of 33,003 HCV-infected, DAA-treated Veterans between 2013 and 2015. Body mass index was used to categorize patients into underweight ( 35 kg/m2). Diabetes was defined by ICD-9/10 codes in association with hemoglobin...
BACKGROUND Malnutrition is frequent in patients with cirrhosis and has been associated with poor prognosis. The Model for End-stage Liver Disease (MELD) score was created to predict survival after Transjugular Intrahepatic Porto-systemic Shunt (TIPS) but lacks a nutritional parameter. AIMS To evaluate the prognostic value of serum cholesterol in patients with cirrhosis undergoing TIPS and to develop a prognostic score to predict survival. METHODS An explorative cross-sectional study was conducte...
Background and aims Lipid metabolism is often disrupted in liver cirrhosis. The present study aimed to evaluate the impact of lipid profile on decompensation events, severity of liver dysfunction, and death in patients with liver cirrhosis. Methods In a cross-sectional study, 778 patients with lipid profile data were enrolled, and then were divided into 240 and 538 patients with and without liver cirrhosis, respectively. In a cohort study, 314 cirrhotic patients with lipid profile data, who were...
PURPOSE OF REVIEW Statins are a class of lipid lower medications used primarily in patients with high-risk cardiovascular disease. Since their development, statins have been considered to be harmful in patients with liver disease, and many of the prescribing information labels consider them to be contraindicated in patients with active liver disease. However, recent studies have shown the contrary, warranting further investigation and discussion. This review aims to describe the latest literatur...
Last. Junko Tanaka(Hiroshima University)H-Index: 28
view all 1 authors...
The development of nuleos(t)ide analogues (NAs) has dramatically changed the natural history of chronic hepatitis B virus (HBV) infection. In this study, we compared patients with HBV-related decompensated cirrhosis with and without NA therapy in terms of hepatocarcinogenesis and all-cause, liver-related, and non-liver-related mortality. This study enrolled 160 patients with decompensated cirrhosis, 78 of whom were treated with NA therapy (NA group) and 82 of whom were not (non-NA group). Propen...
Direct-acting antivirals (DAAs) efficiently eradicate the hepatitis C virus (HCV). Low-density lipoprotein (LDL) levels increase rapidly upon DAA treatment. Proprotein convertase subtilisin/kexin 9 (PCSK9) induces degradation of the hepatic LDL receptor and thereby elevates serum LDL. The aim of this study was to determine serum PCSK9 concentrations during and after DAA therapy to identify associations with LDL levels. Serum PCSK9 was increased in 82 chronic HCV-infected patients compared to 55 ...
#2Marina Serper(UPenn: University of Pennsylvania)H-Index: 21
Last. Anna S. Lok(UM: University of Michigan)H-Index: 59
view all 14 authors...
Patients with nonalcoholic fatty liver disease (NAFLD) are at an increased risk of cardiovascular disease. Hydoxy-3-methyglutaryl-coenzyme reductase inhibitors, statins, reduce the risk of cardiovascular events.1 Studies have shown that statins are safe among patients with liver disease, including those with compensated cirrhosis,2 and their use is associated with lower mortality, hepatic decompensation, and possibly hepatocellular carcinoma.3,4 Despite these data, statins are under prescribed a...