Neil Osterweil

November 15, 2016

BOSTON — For patients with compensated or decompensated alcoholic cirrhosis, statins can cut the risk for death in half, according to a retrospective study.

In addition, there is a substantial reduction in the risk for decompensation with statins.

"I think clinicians are afraid to use statins in this population because of the potential for infection of the liver," said Ulrich Bang, MD, PhD, from the University Hospital of Hvidovre in Denmark.

But this study should allay those fears. "Statins are mainly prescribed by general practitioners," Dr Bang told Medscape Medical News. These doctors need to be informed that they should not be afraid to use statins in patients with alcoholic cirrhosis.

The results of the study were presented here at The Liver Meeting 2016.

There is a growing body of evidence suggesting that statins can reduce the risk for death in patients with cirrhosis caused by hepatitis B, hepatitis C, and other infections, and the drugs have been associated with significant decreases in hepatic venous pressure gradients in randomized studies, Dr Bang reported.

He cited a recent study in which patients with cirrhosis received bleeding prophylaxis with standard therapy with or without statins (Gastroenterology. 2016;150:1160-1170.e3). Statins improved survival in patients with Child–Pugh class A or B cirrhosis, but not in patients with class C cirrhosis. However, the study was not powered to look at a difference in mortality rates.

To see whether statins might have a similar effect in patients with alcoholic cirrhosis, Dr Bang and his colleagues drew on Denmark's all-encompassing patient, prescription, and mortality registries to identify patients with a diagnosis of alcoholic cirrhosis of the liver.

The team looked at variables such as year of cohort entry, age at diagnosis of cirrhosis, sex, socioeconomic status, use of beta blockers and diuretics, and regular statin use, defined as at least two prescriptions for the drugs.

In their propensity score matched cohort, 2275 patients had compensated cirrhosis and 1435 had decompensated cirrhosis. In each group, 25% of the patients were statin users.

Mortality Rates Halved

The primary end point of the study was the incidence of death at 15 years.

Table. Outcomes

Cirrhosis Group Statin Users Nonusers P Value
   Incidence of death at 15 years 31% 50% <.0001
   Median survival 7.8 years 3.5 years <.0001
   Incidence of death at 15 years 38% 54% <.0001
   Median survival 3.9 years 2.2 years <.0001


Mortality rates were lower in statin users than in nonusers for patients with compensated cirrhosis (86 vs 199 per 1000 person-years; adjusted hazard ratio [aHR], 0.45; P < .0001) and for those with decompensated cirrhosis (132 vs 290 per 1000 person-years; aHR, 0.55; P <.0001).

The risk for decompensation — a secondary end point — was also lower in statin users than in nonusers (10% vs 25%; aHR 0.31; P < .0001).

Statins are thought to have an anti-inflammatory effect on the liver and have been shown to reduce portal hypertension, which is a prognostic marker for death, Dr Bang told Medscape Medical News.

Statins have also been shown to reduce the progression of liver fibrosis, said session moderator Raymond Chung, MD, director of hepatology at the Massachusetts General Hospital in Boston.

Practice Changing?

"These are brand new data with regard to survival. For patients with any whiff of an indication for the use of statins, I think they should stay on statins. But it's a little early to make a recommendation about the use of statins in alcoholic cirrhosis because this was retrospective study," Dr Chung said.

This study was done well and propensity score matching was used to rule out as many confounders as possible, but a randomized controlled trial will be necessary to confirm the results, he told Medscape Medical News.

The study was funded by the Danish government. Dr Bang and Dr Chung have disclosed no relevant financial relationships.

The Liver Meeting 2016: American Association for the Study of Liver Diseases (AASLD): Abstract 251. Presented November 14, 2016.


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