EFFECT OF STATIN USE ON THE RISK OF ADVANCED LIVER DISEASE AND MORTALITY AMONG PATIENTS WITH CHRONIC LIVER DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Author(s)
Shao-Hsuan Chang, MS1, Ashley Stultz, PharmD1, Chanakan Jenjai, PharmD1, Hung-Kai (Henry) Chen, MClinPharm1, Chien-Yu Tseng, PharmD1, Roniel Cabrera, MD2, Haesuk Park, PhD1;
1Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA, 2Department of Gastroenterology, College of Medicine, University of Florida, Gainesville, FL, USA
1Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA, 2Department of Gastroenterology, College of Medicine, University of Florida, Gainesville, FL, USA
OBJECTIVES: This systematic review and meta-analysis evaluated associations between statin use and risks of advanced liver disease and mortality among patients with chronic liver disease (CLD).
METHODS: We systematically searched PubMed, Embase, Web of Science, and CENTRAL through February 2025 for clinical trials and observational studies evaluating statin use versus non-use among adults (≥18 years) with CLD. CLD included viral hepatitis, metabolic dysfunction-associated steatotic liver disease, and alcoholic liver disease. We included studies reporting outcomes of advanced liver disease (decompensated cirrhosis [DCC] and hepatocellular carcinoma [HCC]) or all-cause mortality. Two independent reviewers screened studies and extracted data, with a third reviewer resolving any disagreements. Random-effects meta-analysis was used to estimate pooled hazard ratios (HR) with 95% confidence intervals (CI). Sensitivity analyses restricted to studies without potential immortal time bias were conducted. Subgroup analyses assessed heterogeneity by cirrhosis status (with vs. without cirrhosis).
RESULTS: Of 1,990 studies screened, 50 studies including 4,027,648 patients met inclusion criteria. Statin use was associated with significantly decreased risks of DCC (n=10, HR 0.58; CI 0.48-0.69), HCC (n=23, HR 0.56; CI 0.51-0.62), and all-cause mortality (n=25, HR 0.67; CI 0.61-0.74). Sensitivity analyses restricted to studies without potential immortal time bias showed a slightly attenuated preventive effect of statin use on the risk of DCC (HR 0.64; CI 0.51-0.80), HCC (HR 0.62; CI 0.54-0.70), and all-cause mortality (HR 0.78; CI 0.71-0.86). These associations were consistent by cirrhosis status for DCC (with: HR 0.56; CI 0.44-0.71; without: HR 0.55; CI 0.36-0.83), HCC (with: HR 0.55; CI 0.42-0.73; without: HR 0.51; CI 0.37-0.70), and all-cause mortality (with: HR 0.60; CI 0.52-0.69; without: HR 0.89; CI 0.80-0.99).
CONCLUSIONS: Statin use was associated with significantly lower risks of advanced liver disease and mortality among patients with CLD, with consistent findings across sensitivity and subgroup analyses.
METHODS: We systematically searched PubMed, Embase, Web of Science, and CENTRAL through February 2025 for clinical trials and observational studies evaluating statin use versus non-use among adults (≥18 years) with CLD. CLD included viral hepatitis, metabolic dysfunction-associated steatotic liver disease, and alcoholic liver disease. We included studies reporting outcomes of advanced liver disease (decompensated cirrhosis [DCC] and hepatocellular carcinoma [HCC]) or all-cause mortality. Two independent reviewers screened studies and extracted data, with a third reviewer resolving any disagreements. Random-effects meta-analysis was used to estimate pooled hazard ratios (HR) with 95% confidence intervals (CI). Sensitivity analyses restricted to studies without potential immortal time bias were conducted. Subgroup analyses assessed heterogeneity by cirrhosis status (with vs. without cirrhosis).
RESULTS: Of 1,990 studies screened, 50 studies including 4,027,648 patients met inclusion criteria. Statin use was associated with significantly decreased risks of DCC (n=10, HR 0.58; CI 0.48-0.69), HCC (n=23, HR 0.56; CI 0.51-0.62), and all-cause mortality (n=25, HR 0.67; CI 0.61-0.74). Sensitivity analyses restricted to studies without potential immortal time bias showed a slightly attenuated preventive effect of statin use on the risk of DCC (HR 0.64; CI 0.51-0.80), HCC (HR 0.62; CI 0.54-0.70), and all-cause mortality (HR 0.78; CI 0.71-0.86). These associations were consistent by cirrhosis status for DCC (with: HR 0.56; CI 0.44-0.71; without: HR 0.55; CI 0.36-0.83), HCC (with: HR 0.55; CI 0.42-0.73; without: HR 0.51; CI 0.37-0.70), and all-cause mortality (with: HR 0.60; CI 0.52-0.69; without: HR 0.89; CI 0.80-0.99).
CONCLUSIONS: Statin use was associated with significantly lower risks of advanced liver disease and mortality among patients with CLD, with consistent findings across sensitivity and subgroup analyses.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO135
Topic
Clinical Outcomes
Topic Subcategory
Relating Intermediate to Long-term Outcomes
Disease
SDC: Gastrointestinal Disorders