High‐Intensity Statin Reduces the Risk of Mortality Among Chronic Liver Disease Patients With Atherosclerotic Cardiovascular Disease: A Population‐Based Cohort Study
Background 2018 American Heart Association/American College of Cardiology cholesterol guideline recommends statin in patients with chronic and/or stable liver disease for secondary prevention of atherosclerotic cardiovascular disease yet remains equivocal on the adequate intensity of statin for pati...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.028310 |
| _version_ | 1797662597340725248 |
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| author | Sungho Bea In‐Sun Oh Ju Hwan Kim Dong Hyun Sinn Yoosoo Chang Seungho Ryu Ju‐Young Shin |
| author_facet | Sungho Bea In‐Sun Oh Ju Hwan Kim Dong Hyun Sinn Yoosoo Chang Seungho Ryu Ju‐Young Shin |
| author_sort | Sungho Bea |
| collection | DOAJ |
| description | Background 2018 American Heart Association/American College of Cardiology cholesterol guideline recommends statin in patients with chronic and/or stable liver disease for secondary prevention of atherosclerotic cardiovascular disease yet remains equivocal on the adequate intensity of statin for patients with chronic liver disease (CLD). We aimed to assess the association between statin intensity and mortality among patients with CLD with atherosclerotic cardiovascular disease. Methods and Results We conducted a population‐based cohort study in South Korea. We assessed the risk of survival and clinical outcomes using inverse probability of treatment‐weighted Cox proportional hazards regression. We also estimated the absolute risk difference between treatment groups based on the Poisson distribution. During an average of 2.35 person‐years, 10 442 patients with CLD with atherosclerotic cardiovascular disease were identified. Among those patients, 5515 (52.8%) received high‐intensity statin, and 4927 (47.2%) received low/moderate‐intensity statin. High‐intensity statin was associated with lower risk for all‐cause mortality (hazard ratio [HR], 0.83 [95% CI, 0.75–0.92]), cardiovascular‐cause mortality (HR, 0.85 [0.71–1.01]), liver‐cause mortality (HR, 0.72 [0.54–0.97]) compared with low/moderate‐intensity statin. Although both hospitalizations for recurrent myocardial infarction and stroke were shown to be increased among high‐intensity statin users, effect estimate was homogeneous in the absolute scale (myocardial infarction: HR, 1.12 [1.04–1.19], risk difference, 7.57 [−0.69 to 15.84] per 1000 person‐years; stroke: HR, 1.11 [0.97 to 1.27]; risk difference, −1.70 [−5.19 to 1.78]). Conclusions Among patients with CLD with atherosclerotic cardiovascular disease, high‐intensity statin was significantly associated with a lower risk of mortality. These findings herein support the guidelines for statin use in patients with CLD while demonstrating potential benefit of optimal intensity use. |
| first_indexed | 2024-03-11T19:02:34Z |
| format | Article |
| id | doaj.art-8e099d1b7e184acfb555c133cc93dc89 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-11T19:02:34Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-8e099d1b7e184acfb555c133cc93dc892023-10-10T11:37:42ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-04-0112810.1161/JAHA.122.028310High‐Intensity Statin Reduces the Risk of Mortality Among Chronic Liver Disease Patients With Atherosclerotic Cardiovascular Disease: A Population‐Based Cohort StudySungho Bea0In‐Sun Oh1Ju Hwan Kim2Dong Hyun Sinn3Yoosoo Chang4Seungho Ryu5Ju‐Young Shin6School of Pharmacy Sungkyunkwan University Suwon South KoreaSchool of Pharmacy Sungkyunkwan University Suwon South KoreaSchool of Pharmacy Sungkyunkwan University Suwon South KoreaDivision of Gastroenterology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDepartment of Biohealth Regulatory Science Sungkyunkwan University Suwon South KoreaCenter for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of KoreaSchool of Pharmacy Sungkyunkwan University Suwon South KoreaBackground 2018 American Heart Association/American College of Cardiology cholesterol guideline recommends statin in patients with chronic and/or stable liver disease for secondary prevention of atherosclerotic cardiovascular disease yet remains equivocal on the adequate intensity of statin for patients with chronic liver disease (CLD). We aimed to assess the association between statin intensity and mortality among patients with CLD with atherosclerotic cardiovascular disease. Methods and Results We conducted a population‐based cohort study in South Korea. We assessed the risk of survival and clinical outcomes using inverse probability of treatment‐weighted Cox proportional hazards regression. We also estimated the absolute risk difference between treatment groups based on the Poisson distribution. During an average of 2.35 person‐years, 10 442 patients with CLD with atherosclerotic cardiovascular disease were identified. Among those patients, 5515 (52.8%) received high‐intensity statin, and 4927 (47.2%) received low/moderate‐intensity statin. High‐intensity statin was associated with lower risk for all‐cause mortality (hazard ratio [HR], 0.83 [95% CI, 0.75–0.92]), cardiovascular‐cause mortality (HR, 0.85 [0.71–1.01]), liver‐cause mortality (HR, 0.72 [0.54–0.97]) compared with low/moderate‐intensity statin. Although both hospitalizations for recurrent myocardial infarction and stroke were shown to be increased among high‐intensity statin users, effect estimate was homogeneous in the absolute scale (myocardial infarction: HR, 1.12 [1.04–1.19], risk difference, 7.57 [−0.69 to 15.84] per 1000 person‐years; stroke: HR, 1.11 [0.97 to 1.27]; risk difference, −1.70 [−5.19 to 1.78]). Conclusions Among patients with CLD with atherosclerotic cardiovascular disease, high‐intensity statin was significantly associated with a lower risk of mortality. These findings herein support the guidelines for statin use in patients with CLD while demonstrating potential benefit of optimal intensity use.https://www.ahajournals.org/doi/10.1161/JAHA.122.028310atherosclerotic cardiovascular diseasechronic liver diseaseepidemiologypreventionstatin intensity |
| spellingShingle | Sungho Bea In‐Sun Oh Ju Hwan Kim Dong Hyun Sinn Yoosoo Chang Seungho Ryu Ju‐Young Shin High‐Intensity Statin Reduces the Risk of Mortality Among Chronic Liver Disease Patients With Atherosclerotic Cardiovascular Disease: A Population‐Based Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atherosclerotic cardiovascular disease chronic liver disease epidemiology prevention statin intensity |
| title | High‐Intensity Statin Reduces the Risk of Mortality Among Chronic Liver Disease Patients With Atherosclerotic Cardiovascular Disease: A Population‐Based Cohort Study |
| title_full | High‐Intensity Statin Reduces the Risk of Mortality Among Chronic Liver Disease Patients With Atherosclerotic Cardiovascular Disease: A Population‐Based Cohort Study |
| title_fullStr | High‐Intensity Statin Reduces the Risk of Mortality Among Chronic Liver Disease Patients With Atherosclerotic Cardiovascular Disease: A Population‐Based Cohort Study |
| title_full_unstemmed | High‐Intensity Statin Reduces the Risk of Mortality Among Chronic Liver Disease Patients With Atherosclerotic Cardiovascular Disease: A Population‐Based Cohort Study |
| title_short | High‐Intensity Statin Reduces the Risk of Mortality Among Chronic Liver Disease Patients With Atherosclerotic Cardiovascular Disease: A Population‐Based Cohort Study |
| title_sort | high intensity statin reduces the risk of mortality among chronic liver disease patients with atherosclerotic cardiovascular disease a population based cohort study |
| topic | atherosclerotic cardiovascular disease chronic liver disease epidemiology prevention statin intensity |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.028310 |
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