Impacts of Hypercholesterolemia and Statin Use in Cirrhosis

Statin Drug-Drug Interactions
Statin Drug-Drug Interactions
A team of investigators sought to identify the independent effects of hyperlipidemia and statin exposure on mortality, hepatic decompensation, and hepatocellular carcinoma in individuals with cirrhosis.

Statin use in well-compensated patients with cirrhosis was found to be associated with a decrease in risk of incident hepatic decompensation events and liver cancer incidence, according to a study published in Gastroenterology.

A team of researchers conducted a retrospective cohort study of patients who were newly diagnosed with cirrhosis to determine the effects of hyperlipidemia and statin exposure on mortality and risk of hepatic decompensation and hepatocellular carcinoma.

A total of 129,051 patients with newly diagnosed cirrhosis were identified via the Corporate Data Warehouse of the Veterans Health Administration and 74,984 were analyzed. Patients were sorted into groups by exposure of lipid-lowering agent type: statins, non-statins, or none. Patients who received non-statin lipid-lowering agents were excluded.

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Prior to diagnosis, approximately 29% of patients used statins and nearly 70% received no lipid-lowering agents. For statin-naive individuals, every 10-mg/dL increase in baseline total cholesterol was associated with a 3.6% decrease in mortality.

For statin users, each year of continued statin use was linked to reduced mortality (hazard ratio [HR], 0.920). Similarly, each year of statin use for new users was also associated with a reduction in mortality (HR, 0.913).  

“Among a large, national sample of veterans with cirrhosis, exposure to statin therapy was associated with an 8.0% to 8.7% annual reduction of mortality after comprehensive adjustment for hyperlipidemia as well as other covariates highly associated with hepatic and cardiac mortality,” the authors noted.

“Prospective randomized controlled trials to evaluate the impact of statin therapy in patients with [Child-Turcotte-Pugh classes A and B] cirrhosis powered based on the effect size presently observed are recommended to validate these retrospective findings,” concluded the investigators.


Kaplan DE, Serper M, Mehta R, et al; for the VOCAL Study Group. Effects of hypercholesterolemia and statin exposure on survival in a large national cohort of patients with cirrhosis [published online January 9, 2019]. Gastroenterology. doi:10.1053/j.gastro.2019.01.026

This article originally appeared on Clinical Advisor