Paul Naylor, Eugene Verkhovsky, Anupama Devara, Sindhuri Benjaram, Murray Ehrinpreis and Milton Mutchnick*
Department of Internal Medicine, Wayne State University School of Medicine, USAFulltext PDF
Background: Statins are 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors which have the potential to modify HCV host cell lipid metabolism and thus could have an impact on outcomes of viral infection. Epidemiologic studies of the association between statin use and worsening of liver disease parameters such as fibrosis and the incidence of Hepatocellular Carcinoma (HCC) have generated inconsistent results. In addition, most studies have been of small sample size and few studies have included significant numbers of African American (AA) participants who were not on anti-viral therapy (i.e natural history cohort). Our objective was to investigate the impact of statins upon fibrosis, cirrhosis and HCC in our predominantly African-American population.
Methods: The EMR of the largest health care provider in Southeast Michigan and its associated multi-specialty group were use to identify all the patients with HCV who had at least one visit over a period of 1 year (2015). Patients who were on treatment were included if pre-treatment data was available. Stratification was into 2 groups based on the presence of prescriptions for statins in their 2015 EMR records. HIV and Hepatitis B co infected patients were excluded. Liver fibrosis was defined by APRI [ (AST/ AST normal)/ Platelet ×100] and FIB-4 [(Age × AST)/(Platelet × √ALT)] scores. Cirrhosis was defined by a combination of laboratory data and imaging studies. HCC was diagnosed by imaging and/or biopsy.
Results: From a data set of 459 patients with HCV, we identified 150 patients who were prescribed statins and compared them to 309 patients who were not. Patients were similar in gender, race and BMI. Statin use was associated with significantly lower Fibrosis defined by APRI (0.6 vs 0.9; P<0.005) and Fib 4 (2.1 vs 2.8; P<0.05). Patients on statins also had lower cirrhosis than those who were not (12% vs 21%; p< 0.05) by Fischer's chi square test. Although not statistically different patients on statins were less likely to develop HCC (2 pts vs 7 pts).
Conclusion: In a predominately AA patient population with chronic HCV, statin use is associated with reduced fibrosis, cirrhosis and with a decrease in HCC risk. Given that statins are underutilized by many primary care providers, these results provide additional evidence that statins use is beneficial in preventing liver disease progression in patients with Hepatitis C infection.
Naylor P, Verkhovsky E, Devara A, Benjaram S, Ehrinpreis M, Mutchnick M. Statin Use is Associated with Reduction in Fibrosis and Cirrhosis in a Predominantly African American Urban Population with Hepatitis C. Ann Digest Liver Dis. 2018; 1(2): 1006.