High prevalence of dyslipidemia but insufficient statin use in patients with non-cirrhotic and cirrhotic liver disease

Background:

Chronic liver disease (CLD) affects the lipoprotein synthesis, while dyslipidemia increases the risk for cardiovascular disease. Besides their lipid-lowering effect, recent data suggest hepatoprotective effects of statins. Therefore, we investigated lipid profiles in patients with non-cirrhotic and cirrhotic CLD of different etiologies, as well as the utilization of statins in these patients.

Methods:

We used transient elastography (TE) for diagnosing cirrhosis (≥15kPa) and controlled attenuation parameters (CAP) for steatosis assessment. Patients with alcoholic liver disease (ALD; n = 121), hepatitis C (HCV, n = 1438), hepatitis B (HBV, n = 384), NAFLD (n = 532), cholestatic liver disease (n = 119), or autoimmune hepatitis (AIH, n = 114) were included. Patient characteristics were recorded at the time of TE/CAP measurement.

Results:

Total cholesterol levels were lower in patients with cirrhosis when compared to non-cirrhotic patients across all etiologies. LDL levels were significantly lower in patients with cirrhosis due to HCV, HBV, NAFLD and AIH – but not in ALD and cholestatic cirrhosis. HDL was lower in cirrhosis due to HCV and NAFLD as compared to patients without cirrhosis with same etiology. Triglyceride levels were not affected by cirrhosis in any etiology. Metabolic comorbidities were more prevalent in patients with cirrhosis (diabetes mellitus: ALD: 11.7% vs. 20.5%, HCV: 5.6% vs. 24.3%, HBV: 4.0% vs. 30.8%, NAFLD: 17.0% vs. 36.9%, Cholestatic: 9.1% vs. 15.0% and AIH8.9% vs. 15.4; arterial hypertension: ALD: 55.8% vs. 64.1%, HCV: 23.6% vs. 52.3%, HBV: 15.6% vs. 57.7%, NAFLD: 37.8% vs. 57.9%, cholestatic: 37.4% vs. 65.0%, AIH: 26.7% vs. 46.2% in patients without vs. with cirrhosis, respectively). In general, statins were underutilized in patients with CLD with up to > 50% not receiving indicated lipid-lowering therapy. Interestingly, the rates of underutilization were higher in patients without cirrhosis.

Conclusion:

Dyslipidemia and cardiovascular comorbidities are common in patients with chronic liver disease. Progression to cirrhosis affects total cholesterol and HDL/LDL levels. Statins are underutilized, especially in non-cirrhotic patients.