Statin Use and Acute Liver Injury Among Veterans With and Without HCV, HIV

Patients using statins had a lower risk for any acute liver injury outcome within 18 months compared with non-users, regardless of HIV and/or hepatitis C virus (HCV) status, according to data published in the American Journal of Cardiovascular Drugs.

Researchers performed a retrospective cohort study, spanning January 2000 to December 2018, to evaluate the relationship between acute liver injury and statins using data from the Veterans Affairs Informatics and Computing Infrastructure database. Acute liver injury defined as aminotransferase > 200 U/L, severe acute liver injury, and hospitalization with acute liver injury was compared between statin users and non-users among veterans without infection, HCV monoinfection, HIV/HCV coinfection, and HIV monoinfection.

A total of 166,439 patients met the study criteria; patients who were initiated on statins were older, had higher values of body mass index, higher values of low-density lipoprotein cholesterol and triglycerides, and lower values of high-density lipoprotein cholesterol. The highest rates of acute liver injury occurred in the HCV monoinfection and HIV/HCV coinfection cohorts and statin users had lower rates across all outcomes of acute liver injury compared with non-users in unadjusted analysis.

Statin use of all intensities were also associated with a lower risk for all acute liver injury outcomes compared with non-users and patients on a high intensity were not associated with a statistically significant increase in risk for any acute liver injury outcome. The data also showed there was a reduced risk for any acute liver injury outcome across all cohorts, for each additional 30 days of treatment. The greatest reduction in risk for acute liver injury (12%; hazard ratio, 0.88; 95% CI, 0.81-0.94) was noted among veterans with HIV monoinfection who received moderate-intensity statins.

The results presented in this study may not be generalizable outside of the Veterans Administration Healthcare System and baseline FIB-4 score and follow-up AST/ALT laboratory results were inclusion criteria that may also limit generalizability. Unmeasured factors might have confounded results because this was a retrospective cohort and patients were not randomly assigned to the statin or non-statin groups. Another limitation to the study was that filled prescriptions were used to measure adherence, however studies have suggested this is a good depiction of actual adherence.

Investigators concluded that this nationwide cohort of US veterans demonstrated that, “statin initiators had lower incidence rates and risk of [acute liver injury] compared with non-users, irrespective of HIV or chronic HCV status in unadjusted and propensity score-adjusted models.” Although the study presented several benefits of statin initiators, a better understanding of the risks and benefits of statin use, including intensity, and the occurrence of acute liver injury should be addressed in future research.

Reference

Sutton SS, Magagnoli J, Cummings TH, Hardin JW. Association between statin use, intensity and acute liver injury in human immunodeficiency virus, hepatitis C virus, and uninfected US veterans [published online April 1, 2020]. Am J Cardiovasc Drugs. doi:10.1007/s40256-020-00404-2