Statin use may not be associated with less progression of liver fibrosis in the general population, according to new data presented at the EASL Congress 2024.
“Statin use in liver disease is a topic of discussion,” said Jesse Pustjens, MD, a PhD candidate in hepatology at Erasmus University Medical Center, in Rotterdam, Netherlands, who led the study. He told Gastroenterology & Endoscopy News that “previous cross-sectional studies in at-risk populations suggest a potential protective effect of statins.”
However, Dr. Pustjens and his co-investigators were motivated to conduct this analysis because of “limited longitudinal data on statin use and liver fibrosis in the general population.”
Related Content
They conducted a new analysis of the Rotterdam Study, a prospective, population-based cohort study of adults ages 45 years and older in Rotterdam (abstract SAT-200-YI). They included participants with at least two valid FibroScan (Echosens) liver stiffness measurements (LSMs) who did not have a history of congestive heart failure and did not already take statins. The investigators followed participants to compare LSM in patients who began statins and patients who did not begin statins.
In addition to LSM, the investigators collected data on patient demographics (e.g., age and sex), indicators of metabolic health (e.g., waist circumference, body mass index, prediabetes/diabetes, hypertension, metabolic disorder and hepatic steatosis), and relevant biochemical markers (e.g., total cholesterol, high-density lipoprotein, triglycerides, alanine aminotransferase), and alcohol use. To account for baseline differences in these covariates and allow for a more balanced comparison between statin initiators versus noninitiators, the researchers applied inverse probability of treatment weighting.
In total, 564 patients, who were an average of 71 years of age, were included in the study,. Of these participants, 44% were male, nearly half had prediabetes/diabetes, and about one-third had hepatic steatosis. A median of 4.4 years of follow-up occurred between the first and second LSMs for these patients, and during the follow-up period 18% (n=104) initiated statin use.
Accounting for baseline differences in demographics, indicators of metabolic health, relevant biomarkers and alcohol use between those who initiated statins and those who did not, the investigators found that statin use had no significant effect on LSM (change, –0.12; 95% CI, –0.52 to 0.28; P=0.56).
The investigators also noted that this lack of an association held for all subgroup analyses, including looking only at age, sex, different statin doses, and the presence of certain diseases such as diabetes.
“Our data may suggest that over a median follow-up of 4.4 years, no clinically significant impact from stain use is expected on liver fibrosis progression,” Dr. Pustjens said, but he acknowledged that the available follow-up in his study, specifically between statin initiation and the second LSM “could be too short to detect any significant effects of statin therapy.” He added that it is “also possible that in the general population, the effect of statins on fibrosis could be limited and may only become clinically relevant in individuals with a strict indication for their use.”
To answer these questions, Dr. Pustjens said he and his co-investigators are working on expanding their analysis, including extending the follow-up period and increasing the number of participants.
Ashwani K. Singal, MD, MS, a professor of medicine at the University of Louisville School of Medicine and transplant hepatologist at Jewish Hospital and Trager Transplant Center, in Kentucky, who was not involved in the study, noted that although this abstract stood out to him, he would like to know additional details to be able to contextualize the results. Specifically, he thought it would be helpful to have more information on the duration of statin therapy before the second LSM and details on how metabolic health indicators and biomarker levels changed from baseline.
The sources reported no relevant financial disclosures. Dr. Singal is a member of the Gastroenterology & Endoscopy News editorial board.