Statins In The Population Of Hepatitis B Virus Infection Liver Safety,

Part I Survey of hepatitis B virus infection in patients with coronary heart disease in taking statinsObjective TO investigate the hepatitis B virus (HBV) infection in patients with coronary heart disease(CHD) receiving statins therapy. Methods Clinical data of 2260 patients with CHD receiving statins therapy were retrospectively analyzed. Results Of 2260 patients, 446 cases(19.73%) had a history of HBV infection The difference of HBV infection rate was seen among age groups(P<0.05). The highest rate of HBV infection occured in those greater than 80 years old(23.64%). All patients took more than two kinds of drugs metabolised via cytochrome P450. Conclusion The patients with CHD, especially the elderly, received statins therapy has a high rate of HBV infection. Many CHD patients took variety of medicine which have the same metabolic pathway in the liver as statins at the same time. Attention should be paid to the monitoring of liver function in them.Part II Correlation between hepatotoxicity of statins and history of HBV infectionObjective To evaluate the correlation between hepatotoxicity of statins and history of HBV infection. Methods Retrospective review of patients who were receiving statins therapy. Patients were divided into HBV infection group (with HBV infection history) and negative group (no history of HBV infection) according to whether there is history of HBV infection. Changes of liver biochemistry values within 3.5 months compared with baseline were investigated after statins therapy. Results: 340 cases were included in this study, of those 174 cases (HBV infection group) and 166 cases (negative group) were matched for age, sex, disease diagnosis, smoking history, alcohol abuse, drug use, baseline liver and kidney function, blood lipids, blood glucose and follow-up time. Statins therapy was associated with a higher incidence of liver biochemistry value increases in patients of HBV infection group than in negative group. A significant difference in the percentage of patients discontinued statin therapy with ALT value increases>3 ULN between HBV infection group and negative group (2.87% vs 0.00%, respectively, p=0.027) was found, and it is significant higher than in general population (2.87% vs 1.00%, p=0.031). Two of five cases in HBV infection group who discontinued statins therapy with ALT value increases>3 ULN were treated again with statins after liver function return to normal, Elevated ALT were still found one month later; two of those did not take statins again; one patient lost. Multivariate regression analysis identified the history of HBV infection associated with an increase risk of liver biochemistry value elevation (? =11.77 t=4.36 p= 0.000). Conclusion: Statin therapy was associated with a higher risk of hepatotoxicity in patients have history of HBV infection, these patients should be strengthened to monitor liver function.PartIII Hepatotoxicity of statins in coronary artery disease patients of hepatitis B virus carriersObjective To evaluate the hepatotoxicity of statins in patients of coronary heart disease (CHD) who are seropositive for hepatitis B virus (HBV), and provide a basis for prescribing statins. Methods 117 cases of CHD were include in this study, of those 39 are HBsAg-positive and 78 HBsAg-negative matched for age, sex. Changes in liver biochemistry values within six months compared with baseline were determined after statins therapy. Results Patients with HBsAg-positive on statin therapy had significant increased change in ALT levels(p<0.05), The overall percentage of patients with ALT abnormal was similar in those with HBsAg-positive and in those with HBsAg-negative (10/39 vs 11/78, p=0.208). However, a significant difference in the percentage of patients discontinued statin therapy with ALT value increases>three times upper limits of normal (ULN) between HBsAg-positive group and HBsAg-negative group (5/39 vs 0/78, respectively, p=0.002) was found. One of the five subjects in HBsAg-positive group whose ALT levels increased three times greater than ULN has accompanied with elevated TB and died of acute liver failure one months later. Multivariate regression analysis identified HBsAg positive to be associated with an increase risk of liver biochemistry value elevation (? =32.74 t=2.46 P=0.015). Conclusion Statin therapy was associated with a higher risk of hepatotoxicity in CHD patients of HBV carriers.These subjects should be strengthened to monitor liver function.