Statins: friend and not an enemy for the patient with cirrhosis?
Statins established in the consciousness of many as’ pill cholesterol «, are inhibitors of hepatic reductase HMG-CoA (3 Hydroxyl-3 Methyl Glutaryl CoA), an enzyme that plays a leading role in the process of production of endogenous cholesterol. Are drugs widely used to control the «bad» LDL cholesterol levels, while also have additional beneficial effects on blood vessels, contributing significantly to the reduction of cardiovascular risk.
Adverse effects of statins include the possibility of toxic effects on the liver. They are usually small increases in liver enzymes (transaminases) that resolve spontaneously without requiring, in most cases, discontinuation of the drug. But what if the patients need to take a statin is simultaneously one advanced chronic liver disease, especially cirrhosis? The latter is the final stage of any chronic infection of the liver, most often by viral hepatitis, metabolic disorders with liver fat accumulation and / or careless use of alcohol. The fact that the fear of hepatotoxicity has negatively affected prescribing statin in patients with cirrhosis, even when very high cholesterol levels coexist.
Current evidence, however, overturn this assumption, showing that statins not only not harmful, but may already benefit patients with cirrhosis. In a recent publication in high impact journal «Gastroenterology», US researchers studied the effects of taking statin long-term evolution of patients with cirrhosis from hepatitis C. From national database (Veteran Affairs Clinical Case Registry, 1996-2009) identified 40 152 patients with cirrhosis of which 2802 were taking a statin (simvastatin 85%). It was observed that patients taking statins had a lower risk of developing serious and potentially fatal complications of cirrhosis (such as bleeding from esophageal varices or hepatocellular cancer) as well as reduced likelihood of death or need for liver transplantation.
It seems that the presence of cirrhosis should not be discouraged from taking statin patients who need according to current indications.