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Effects of Hypercholesterolemia and Statin Exposure on Survival in a Large National Cohort of Patients With Cirrhosis

Kaplan, David E., Serper, Marina A., Mehta, Rajni, Fox, Rena, John, Binu, Aytaman, Ayse, Baytarian, Michelle, Hunt, Kristel, Albrecht, Jeffrey, Njei, Basile, Taddei, Tamar H.·2019·Gastroenterology
DOI 10.1053/j.gastro.2019.01.026
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Abstract

Background & aims Concerns related to hepatotoxicity frequently lead to discontinuation or non-initiation of 3-hydroxy-3-methylglutaryl-coenzyme A reductase therapy in patients with cirrhosis despite data supporting statin use. We investigated the independent effects of hyperlipidemia and statin exposure on mortality, hepatic decompensation, and hepatocellular carcinoma development in a large national cohort of patients with cirrhosis. Methods We performed a retrospective cohort study of patients with newly diagnosed cirrhosis from January 1, 2008 through June 30, 2016 in the Veterans Health Administration. Subjects were divided into 2 cohorts: 21,921 patients with prior statin exposure (existing users) and 51,023 statin-naïve individuals, of whom 8794 subsequently initiated statin therapy (new initiators) and 44,269 did not (non-initiators). Multivariable Cox proportional hazard models with inverse probability weighting were constructed to assess the effects of time-updating lipid profiles and cumulative exposure to statins on survival and hepatic decompensation. Statin-naïve new initiators were propensity matched with non-initiators to simulate a randomized controlled trial of statin use in cirrhosis. Results In statin-naïve subjects, every 10-mg/dL increase in baseline total cholesterol was associated with a 3.6% decrease in mortality. In existing users, each year of continued statin exposure was associated with a hazard ratio of 0.920 (95% confidence interval 0.0.897-0.94…

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Metadata

Authors
Kaplan, D. E., Serper, M. A., Mehta, R., Fox, R., John, B., Aytaman, A., Baytarian, M., Hunt, K., Albrecht, J., Njei, B., & Taddei, T. H.
ORCID
John, Binu
Venue
Gastroenterology
Publisher
Elsevier BV
Published
2019-05
Volume
156
Issue
6
Pages
1693-1706.e12
ISSN
0016-5085
DOI
10.1053/j.gastro.2019.01.026
Cited by
145
References
6
Language
en
Licence

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