(AJ) Association of Mortality by Statin Intensity in Chronic Liver Disease Patients with Atherosclerotic Cardiovascular Disease: A Nationwide Cohort Study

Publication Number: 326

Background: AHA/ACC 2018 Cholesterol guideline recommends statin in patients with chronic and/or stable liver disease for secondary prevention of atherosclerotic cardiovascular disease (ASCVD), yet remains equivocal on the adequate intensity of statin for patients with chronic liver disease (CLD).

Objectives: To assess the association between statin intensity and mortality among CLD patients with ASCVD

Methods: We conducted a retrospective cohort study of the South Korea National Health Insurance System database to identify CLD patients with a diagnosis record of liver cirrhosis and/or viral hepatitis between 1 January 2011 and 31 December 2020. The study cohort included those with ASCVD identified using a procedural code for coronary revascularization. We used a 30-day period following ASCVD diagnosis to determine statin intensity. Follow-up began on the day after exposure assessment period, and patients were followed up until death or end of study (31 Dec 2020), using intention-to-treat approach. Rate differences (RDs) and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of all-cause mortality, cardiovascular (CV) related mortality, liver-related mortality and recurrent ASCVD events were estimated using inverse probability of treatment weighting, comparing high-intensity statin users to low/moderate-intensity statin users.

Results: Of 10,442 study population, 5,515 (52.81%) received high-intensity statin, and 4,927 (47.19%) received low/moderate-intensity statin. During average follow-up of 2.35 person-years, high-intensity statin was associated with lower risk for all-cause mortality (HR, 0.83 [95% CI 0.75 to 0.92]), CV-related mortality (HR, 0.85 [95% CI 0.71 to 1.01]), and liver-related mortality (HR, 0.72 [95% CI 0.54 to 0.97]) compared with low/moderate statin. Although both hospitalizations for recurrent MI and stroke were shown to be increased among high-intensity statin users, the effect estimate was homogenous in the absolute scale (MI: HR 1.12 [1.04 to 1.19], RD 7.57 [-0.69 to 15.84] per 1000 person-years; Stroke: HR 1.11 [0.97 to 1.27]; RD -1.70 [-5.19 to 1.78]).

Conclusions: Our findings not only endorse the 2018 AHA/ACC guidelines for statin use but also highlight the improved mortality benefit associated with high-intensity statin in CLD patients with ASCVD. Further studies, including from randomized clinical trials, are needed to confirm required to provide the decisive evidence for statin use and secondary prevention of ASCVD in patients with underlying liver disease conditions.