Statins and the Risk of Cirrhosis and Its Decompensation in Chronic Hepatitis B Patients

Statin inhibits large hepatitis delta antigen-Smad3 -twist-mediated epithelial-to-mesenchymal transition and hepatitis D virus secretion

“…A group of drugs termed statins (inhibitors of HMG-CoA reductase) reduce biologically intermediate substrates for prenylation, and are widely used for reduction of cholesterol levels with low incidence of side effects. Recently, it was associated with the reduction of the risk of cirrhosis and its decompensation in CHB patients [30,31] and the risk of HCC [32]. In the current study, treatment with statins reduced TGF-β secretion, EMT activity, levels of mesenchymal markers, and HDV release in vitro.…”

Patients With Chronic Liver Disease/Cirrhosis Should Not Take Statin Medications

“…Statin use appears safe and effective in small, noncontrolled studies for the treatment of dyslipidemia in patients with primary biliary cholangitis . Further, large retrospective observational studies have demonstrated reduced risks of fibrosis progression, decompensation, hepatocellular carcinoma (HCC), and death in patients with viral hepatitis B or C who use statins . In fact, in one study of patients with hepatitis B, statin use was not only associated with a decreased risk for HCC, but a decreased risk for all nonliver cancers .…”

“…19 Further, large retrospective observational studies have demonstrated reduced risks of fibrosis progression, decompensation, hepatocellular (HC) carcinoma (HCC), and death in patients with viral hepatitis B or C who use statins. 20,21 In fact, in one study of patients with hepatitis B, statin use was not only associated with a decreased risk for HCC, but a decreased risk for all nonliver cancers. 22 In the posttransplant setting, dyslipidemia is common (62%) and can be treated effectively with statins (ideally fluvastatin or pravastatin), with careful monitoring of drug-drug interactions.…”

Statins Show Promise Against Progression of Liver Disease

“…In six retrospective studies of patients without cirrhosis but with chronic liver diseases, including hepatitis B virus (HBV), hepatitis C virus (HCV), ethanol, and nonalcoholic fatty liver disease (NAFLD), statins such as lovastatin or ATV were associated with decreased progression to cirrhosis and decompensation, often in a dose-dependent manner (Table 1). [35][36][37][38][39][40] In patients with compensated cirrhosis, statins were associated with decreased progression to decompensated cirrhosis and death. 41,42 These benefits were strongly correlated to treatment length, with an 8% to 9% decrease in mortality for each year of treatment in Child-Pugh class A/B cirrhosis.…”