Little is known about the potential impact of statins on progression of non-cirrhotic chronic liver diseases (CLD) to severe liver disease.
Using liver histopathology data in a nationwide Swedish cohort, we identified 3,862 non-cirrhotic individuals with CLD and statin exposure, defined as a statin prescription filled for ≥30 cumulative defined daily doses. Statin users were matched to 3,862 (statin) non-users with CLD through direct 1:1 matching followed by propensity score matching. Cox regression was used to estimate hazard ratios (HRs) for the primary outcome of incident severe liver disease (a composite of cirrhosis, hepatocellular carcinoma (HCC), and liver transplantation/liver-related mortality).
45.3% of CLD patients had non-alcoholic fatty liver disease (NAFLD), 21.9% alcohol-related liver disease (ALD), 17.7% viral hepatitis and 15.1% autoimmune hepatitis (AIH). During follow-up, 234 (6.1%) of statin users vs. 276 (7.1%) of non-users developed severe liver disease. Statin use was associated with a decreased risk of developing severe liver disease (HR=0.60; 95%CI=0.48-0.74). Statistically significantly lower rates of severe liver disease were seen in ALD (HR=0.30; 0.19-0.49) and NAFLD (HR=0.68; 0.45-1.00), but not in viral hepatitis (HR=0.76; 0.51-1.14) or AIH (HR=0.88; 0.48-1.58). Statin use had a protective association in both pre-fibrosis and fibrosis stages at diagnosis. Statin use was associated with lower rates of progression to cirrhosis (HR=0.62; 0.49-0.78), HCC (HR=0.44; 0.27-0.71), and liver-related mortality (HR=0.55; 0.36-0.82).
Among individuals with non-cirrhotic CLD, incident statin use was linked to lower rates of severe liver disease suggesting a potential disease modifying role.
Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.
