Statins appear to be beneficial to patients with cirrhosis, being associated with reduced risks of portal hypertension and its complications as well as death, according to a study.

In a cohort of patients with cirrhosis and an indication for statin use, propensity score?matched analysis showed that statin users had 17-percent lower odds of portal hypertension compared with nonusers (odds ratio [OR], 0.83, 95 percent confidence interval [CI], 0.80?0.85). [AASLD 2024, abstract 4152]

Results for portal hypertension complications were consistent, with statin users having decreased odds of spontaneous bacterial peritonitis (OR, 0.52, 95 percent CI, 0.39?0.67), thrombosis (OR, 0.69, 95 percent CI, 0.64?0.76), hepatic encephalitis (OR, 0.7, 95 percent CI, 0.68?0.74), and hepatorenal syndrome (OR, 0.61, 95 percent CI, 0.52?0.72).

Finally, the odds of mortality were 15-percent lower among statin users vs nonusers (OR, 0.85, 95 percent CI, 0.83?0.88).

“Metabolic dysfunction?associated steatotic liver disease-related cirrhosis is one of the leading aetiologies of liver disease, and [affected] patients frequently have other comorbidities like atherosclerotic cardiovascular disease, hyperlipidemia, cerebrovascular disease, and diabetes mellitus (DM). Statins are commonly prescribed for cardiovascular protection in these patients,” said study author Dr Muhammad Ali Butt from the Allegheny General Hospital in Pittsburgh, Pennsylvania, US.

“[The present] findings underscore the importance of incorporating statins into the management strategy for cirrhosis patients,” Butt added.

He noted that the underprescription of statins, even in patients with clear indications, suggests a need for increased awareness and adherence to guidelines in clinical practice.

For the study, Butt and colleagues used real-world data from the TriNetX database US collaborative Network. They identified a total of 174,825 patients with cirrhosis, of which 72,280 each in the propensity score?matched statin user and nonuser cohorts were included.

Clinical guidelines

Currently, the Baveno VII guidelines advocate for the use of statins in cirrhotic patients who already qualify for statin therapy, given its potential for reducing portal pressure (scientific grade of recommendation A1) and improving overall survival (scientific grade of recommendation B1) in this patient population. This aligns with the EASL* Guidelines, which recommend the use of statins for the management of patients with decompensated cirrhosis.  [J Hepatol 2015;63:743-752; J Hepatol 2018;69:406-460]

The said recommendations were formed based on evidence from four randomized clinical trials (RCTs). In three of these, patients treated with statins had a significant decrease in portal pressure compared with those who received placebo. These three trials included a different percentage of patients receiving propranolol, ranging from 50 percent to 100 percent. The fourth trial showed no significant reduction in portal pressure with statins. In this trial, statin was prescribed in combination with carvedilol instead of propranolol. [Gastroenterology 2009;136:1651-1658; Dig Liver Dis 2015;47:957-963; Eur J Gastroenterol Hepatol 2018;30:54-59; Am J Gastroenterol 2020;115:729-737]

*European Association for the Study of the Liver