Statins help preserve liver function in chronic liver disease

Statins can help preserve liver function in patients with chronic liver disease, according to two studies presented at AASLD 2021— showing that not only are statins protective for the heart, but also for the liver.

The SHUNT-V study enrolled 270 patients (age 61.6 years, male 49 percent) with compensated cirrhosis, Child-Pugh B without refractory ascites, fibrosis stage F3 with platelet count <175,000, refractory encephalopathy, or a history of variceal haemorrhage. [AASLD 2021, abstract 144]

“With disease progression, portal hypertension and portal-systemic shunting increase and liver function declines — leading to clinical complications, such as varices,” explained presenting author Dr Robert Rahimi from the Baylor University Medical Center, Baylor Scott and White, Dallas, Texas, US.

The researchers found that the use of statins was associated with lower DSI — indicating better hepatic function (p=0.0025); as well as lower SHUNT* percentage — denoting less portal-systemic shunting (p=0.0132).

Metformin use was also independently associated with a lower DSI (p=0.0574) and SHUNT percentage (p=0.0475).

Combining the effects of both stain and metformin, concomitant use of the drugs was associated with reduction of both DSI and SHUNT percentage by approximately 21 percent.

As shown in a multi-variable regression model, statin use was the predominant factor driving the lowering of DSI and SHUNT percentage.

“In the SHUNT-V study of clinically stable but advanced chronic liver disease, concomitant use of statins was independently associated with preserved hepatic function and reduced portal-systemic shunting,” Rahimi concluded.

“Improved liver function and reduced portal-systemic shunting should reduce the risk of clinical outcome,” he added, pointing out that "follow-up of the SHUNT-V cohort is being planned.”

“This study [also] highlights the potential utility of the sensitive and reliable dual cholate test [which quantifies SHUNT fraction and generates a DSI] of liver function for detecting treatment effects,” Rahimi said.

In another retrospective cohort study, 122,564 adult patients (median age 62 years, 97.1 percent male, 28.2 percent on statin therapy at baseline) with cirrhosis were identified from the VOCAL database. Researchers compared the clinical outcomes of those who used statins vs non-statin medications for lipid lowering. [AASLD 2021, abstract 205]

Patients who took statins were significantly less likely to be hospitalized for grade2/3 acute on chronic liver failure (ACLF) compared with those on non-statin lipid-lowering therapy (hazard ratio [HR], 0.90; p<0.001).

Furthermore, there appears to be a dose-response relationship, with a greater reduction in grade2/3 ACLF hospitalization with high-dose statins (160 mg) vs low-dose statins (<20 mg; HR, 0.76; p<0.001).

“ACLF is a devastating syndrome with extremely high short-term mortality,” said presenting author Dr Nadim Mahmud from the Perelman School of Medicine, University of Pennsylvania in Philadelphia, Pennsylvania, US.

“Statins have been demonstrated to protect against hepatic decompensation in patients with cirrhosis, and it is plausible that they may similarly reduce the likelihood of future ACLF,” he noted.

*SHUNT: portal systemic shunt fraction

**VOCAL: Veterans Outcomes and Costs Associated with Liver disease