The Use of Statins in Patients With Chronic Liver Disease and Cirrhosis
Purpose of review
Statins are drugs developed to treat hypercholesterolemia. Its use in patients with liver disease has been limited because one of its potential and most feared side effects is hepatotoxicity. However, there is robust evidence that supports the safety of statins in this population in the absence of severe liver dysfunction. In this review, we will summarize the efficacy and safety of statins in cirrhosis.
Statins are effective in the treatment of dyslipidemia in patients with liver disease, because of their pleiotropic properties. These properties are independent of their effect on cholesterol levels, such as improving endothelial dysfunction or having antioxidant, antifibrotic, anti-inflammatory, antiproliferative, antiangiogenic, proapoptotic, or immunomodulation properties. Statins have been studied in other areas such as in treatment of portal hypertension, prevention of hepatocellular carcinoma, and/or protection against ischemia/reperfusion injury.
Approved indications for statins in patients with cirrhosis are those of the general population, including dyslipidemia and increased cardiovascular risk. Compensated cirrhosis is not a contraindication. In patients with decompensated cirrhosis, statins should be prescribed with extreme caution at low doses, and with frequent monitoring of creatinine phosphokinase levels in order to detect adverse events in a timely fashion.
KeywordsHydroxymethylglutaryl-CoA reductase inhibitors Liver cirrhosis End-stage liver disease Chemical- and drug-induced liver injury Hypertension, portal Dyslipidemias
Compliance with Ethical Standards
Conflict of Interest
Carlos Moctezuma-Velázquez declares that he has no conflict of interest. Juan Abraldes declares that he has no conflict of interest. Aldo Montano-Loza declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
- 6.•• Abraldes JG, Villanueva C, Aracil C, Turnes J, Hernandez-Guerra M, Genesca J, et al. Addition of simvastatin to standard therapy for the prevention of variceal rebleeding does not reduce rebleeding but increases survival in patients with cirrhosis. Gastroenterology. 2016;150(5):1160–70 e3. Prospective study that showed a lower mortality in patients that received statins.CrossRefPubMedGoogle Scholar
- 17.•• Kargiotis K, Athyros VG, Giouleme O, Katsiki N, Katsiki E, Anagnostis P, et al. Resolution of non-alcoholic steatohepatitis by rosuvastatin monotherapy in patients with metabolic syndrome. World J Gastroenterol. 2015;21(25):7860–8. This article shows that further investigation is needed regarding the role of statins in the treatment of NAFLD.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.•• Mohanty A, Tate JP, Garcia-Tsao G. Statins are associated with a decreased risk of decompensation and death in veterans with hepatitis c-related compensated cirrhosis. Gastroenterology. 2016;150(2):430–40 e1. One of the largest observational studies showing a benefit of statins in patients with cirrhosis.CrossRefPubMedGoogle Scholar
- 38.http://livertox.nih.gov/.Accessed September 23, 2017.
- 40.Lewis JH, Mortensen ME, Zweig S, Fusco MJ, Medoff JR, Belder R, et al. Efficacy and safety of high-dose pravastatin in hypercholesterolemic patients with well-compensated chronic liver disease: results of a prospective, randomized, double-blind, placebo-controlled, multicenter trial. Hepatology. 2007;46(5):1453–63.CrossRefPubMedGoogle Scholar
- 42.•• Bays H, Cohen DE, Chalasani N, Harrison SA, The National Lipid Association’s Statin Safety Task F. An assessment by the Statin Liver Safety Task Force: 2014 update. J Clin Lipidol. 2014;8(3 Suppl):S47–57. Specific recommendations of a panel of experts about the liver safety of statins; the strength of the recommendations and quality of evidence are given.CrossRefPubMedGoogle Scholar
- 59.•• Kim RG, Loomba R, Prokop LJ, Singh S. Statin use and risk of cirrhosis and related complications in patients with chronic liver diseases: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2017;15:1521–30. Meta-analysis that reinforces the concept that statins may probably decrease mortality in patients with cirrhosis.CrossRefPubMedGoogle Scholar