Acute Liver Injury
The researchers determined that patients prescribed statins were older, had higher body mass index values, higher levels of low-density lipoprotein cholesterol and triglycerides and lower values of high-density lipoprotein cholesterol. Despite these risk factors, in every cohort (HIV infected, HCV infected, co-infected, uninfected) the statin group had lower risk of all acute liver injury outcomes than veterans who were not prescribed statins. The team looked at three levels of acute liver injury: aminotransferase above 200 U/L, severe acute liver injury, and hospitalization with acute liver injury (ALI).
Furthermore, every 30 days on statins reduced the risk of any acute liver injury outcomes across all subgroups. In addition, high intensity statins were not associated with a statistically significant increase in risk for any acute liver injury.
Veterans infected with just HCV and those with HCV/HIV co-infection had the highest rates of acute liver injury but, overall, the study concluded that “statin initiators had a lower risk of any [acute liver injury] outcome compared with non-users within 18 months regardless of HIV and/or HCV status.”
The statins included in the study were atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin and simvastatin.
The analysis confirmed results of several smaller studies of statin use in veterans with HCV or HIV, although it runs counter to a systematic review and meta-analysis that found statin therapy increased the odds of liver injury by 18% (OR 1.18, 95% CI 1.01-1.39), with greater risk among those taking a high dose of fFluvastatin. On the other hand, the team also noted that other recent studies found statins reduced the risk of fibrosis progression in cirrhotic patients with HCV or HCV/HIV co-infection.
The size and details of the study give additional credence to the new study, the authors said. “Given our sample size, we believe the data are robust in evaluating statin use on the risk of ALI. Our study is unique because it (1) evaluated a national cohort of patients; (2) studied several specific disease states (HIV and HCV); (3) evaluated three outcomes for ALI; (4) considered different levels of statin intensity; and (5) utilized liver biomarkers to calculate the FIB-4 score.”
- Weintraub WS. Perspective on Trends in Statin Use. JAMA Cardiol. 2017;2(1):11-12. doi:10.1001/jamacardio.2016.4710
- Sidebottom AC, Vacquier MC, Jensen JC, et al. Trends in prevalence of guideline‐based use of lipid‐lowering therapy in a large health system. Clin Cardiol. 2020;43:560–567. https://doi.org/10.1002/clc.23347
- Sutton SS, Magagnoli J, Cummings TH, Hardin JW. Association Between Statin Use, Intensity and Acute Liver Injury in Human Immunodeficiency Virus, Hepatitis C Virus, and Uninfected US Veterans. Am J Cardiovasc Drugs. [published online ahead of print, 2020 Apr 1]. Am J Cardiovasc Drugs. 2020;10.1007/s40256-020-00404-2. doi:10.1007/s40256-020-00404-2
