Statins and the risk of cirrhosis in hepatitis B or C patients: a systematic review and dose-response meta-analysis of observational studies

Hepatitis B and hepatitis C are leading causes of chronic liver disease, particularly cirrhosis. Recently, several studies have observed that statins have an inverse relationship with cirrhosis in hepatitis B or C patients. However, no published meta-analysis studied the protective effect of statins on cirrhosis. Thus, we conducted a systematic review and meta-analysis of published observational studies to better understand the relationship between statins and the risk of cirrhosis. Relevant studies were identified by searching PubMed, EMBASE, and ISI Web of Science for articles published before April 2017. The Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. Six cohort studies, including 38951 cases of cirrhosis in 263573 patients with hepatitis B or C, were identified to investigate the relationship between statins and the risk of cirrhosis. The Newcastle-Ottawa Scale scores for the included studies ranged from 6 to 9, with four high-quality studies and only two of medium quality. The use of statins was associated with a significant 42% reduction in the risk of cirrhosis, without obvious heterogeneity. In addition, this protective effect was more obvious in Asian countries. Moreover, dose-response analysis suggested each additional 50 cumulative defined daily doses (cDDD) of statins decreases the risk of cirrhosis by 11% (odds ratio [OR] = 0.89, 95% confidence interval [CI] = 0.86-0.93, p = 0.001). In summary, statin use is associated with a decreased incidence rate of cirrhosis and is most pronounced in Eastern countries but also in Western countries.