Meta-analysis:Effects Of Statins Attenuating Progression Of Liver Fibrosis In Patients With Chronic Liver Disease

Background&Aims:Liver fibrosis stage are closely associated with long-term prognosis and mortality in patients with chronic liver disease.Statins have been reported to be effective in patients with NAFLD and dyslipidemia.It also has important anti-inflammatory properties in hepatocytes.However,long-term use of statins have hepatotoxicity.The effects of statins on liver fibrosis have not been consistent across studies.This meta-analysis aims to illustrate the protective role of statins on progression of liver fibrosis and cirrhosis.Methods:A systematic search was perfonned separately by two investigators through Pubmed/Medline,Embase,Cochrane Library and Ovid to identify all studies reporting relationships between statins and liver fibrosis.All studies were limited to articles with an English abstract.Risk of bias of included studies was assessed using the Newcastle-Ottawa scale(NOS)or Agency for Healthcare Research and Quality(AHRQ)tool.Between-study heterogeneity was assessed by computing Higgin's I2 and chi-square test.Pooled statistical parameters were calculated using STATA 12.0 software.Results:A total of 16 studies including 123,938 patientswere included in this meta-analysis.7 studies reported the relationship between statins and significant fibrosis in patients with NAFLD.5 studies showed the effects of statin on risk of cirrhosis in viral hepatitis patients.4 studies provided enough data to evaluate the role of statins in decompensation of cirrhosis.Based on meta-analysis,we found that:1)Risk of significant fibrosis decreased by 28%(RR=0.72,95%CI:0.56-0.93,p=0.013)in NAFLD patients with statins compared with the control.Statins use was also seemed to improve the survival of NAFLD patients.2)Risk of cirrhosis decreased by 60%(RR=0.40,95%Cl:0.39-0.42,p=0.000)among viral hepatitis patients with statins,and this effects were dose-dependent.For every 30 cDDD(cumulative Defined Daily Dose)the dose of satin increase,the risk of cirrhosis would decrease by 14%.3)Statins also deceased the risk of decompensation of cirrhosis to 46%(RR=0.46,95%CI:0.38-0.56,p=0.000),and decreased its mortality.Conclusions:Based on this meta-analysis,statins use could decrease the risk of early fibrosis and cirrhosis among chronic liver disease.Long-term use of statin is also associated with lower mortality in cirrhotic patients.Further prospective studies are needed to confirm these benefits.