Abstract
TITLE: MAXIMIZING THE BENEFITS OF STATIN THERAPY FOR LIVER DISEASE PREVENTION: TARGETING PATIENTS WITH UNMET STATIN THERAPY NEEDS
Background: Chronic liver diseases, such as non-alcoholic fatty liver disease (NAFLD) and viral hepatitis, contribute significantly to liver-related morbidity and mortality. Statins, commonly prescribed for dyslipidemia, have been suggested to possess hepatoprotective effects beyond their lipid-lowering properties. This study aims to assess the association between statin use and liver-related outcomes, including hepatocellular carcinoma incidence and liver-related mortality, utilizing data from the UK Biobank.
Methods: Propensity score matching was employed to match patients without prior liver disease. Patients were matched according to the following criteria: Age, sex, BMI, ethnicity, diabetes mellitus with or without insulin or biguanide use, hypertension, ischemic heart disease, dyslipidemia, aspirin use, and number of medications taken. The study compared primary outcomes between 205,057 statin-users and non-users after matching using cox regression models as well as Fine and Grey models in R. We defined incident liver disease as the occurrence of any new diagnosis of K70-K77 after baseline. Hepatocellular carcinoma was identified using ICD-10 code C22.0, and liver-related death was determined based on deaths attributed to either K70-K77 or C22.0.
Results: In the UK Biobank (n=205,057), statin-users exhibited a 15.4% reduced risk of developing new liver disease (HRUKB=0.846, 95% CI, 0.782-0.915; p=<.001), a 28.0% lower risk of liver-associated death (HRUKB=0.720, 95% CI, 0.588-0.880; p=.001) and a 42% lower risk of hepatocellular carcinoma development (HRUKB=0.580, 95% CI, 0.350-0.963; p=0.04). When comparing statin-users to non-users with an indication for statin therapy but without a statin prescription, the risk reduction for new liver disease increased to 23.6% (HRUKB=0.764, 95% CI, 0.693-0.842; p=<.001).
Conclusion: Our findings strongly suggest that the utilization of statins is linked to a notable reduction in liver-related outcomes, such as the incidence of hepatocellular carcinoma and liver-related mortality. Notably, these findings were even more pronounced when comparing individuals who were prescribed statins to non-users who were likely candidates for statin treatment. Our comprehensive analysis provides robust evidence that underscores the potential preventive benefits of statins on liver disease.