Statins Are Underutilized in Patients with Nonalcoholic Fatty Liver Disease and Dyslipidemia (original) (raw)

Abstract

Background

Cardiovascular disease provides the greatest mortality risk in patients with nonalcoholic fatty liver disease (NAFLD). Clinical practice guidelines recommend statins to treat dyslipidemia in patients with NAFLD; however, the extent to which such patients receive statins has not been studied.

Methods

We conducted a structured medical record review to assess for appropriate statin use in patients in a Veterans Administration facility with dyslipidemia and NAFLD as well as a parallel cohort without NAFLD. Appropriate statin use was defined as receipt of statins without a clinically significant, unjustified dose change during the study period.

Results

Of 255 patients with NAFLD and dyslipidemia, 152 (59.6 %) patients received appropriate statin care. Primary care providers (PCPs) recognized the presence of NAFLD in 106 patients (41.6 %). Among the 63 of 106 (59.4 %) patients who were on a statin at the time of detection, 24 (38.1 %) received a clinically significant dose reduction or discontinuation. Patients whose PCPs recognized the presence of NAFLD (adjusted OR = 0.34, 95 % CI = 0.18–0.64) were less likely to receive appropriate statin care than patients with undetected NAFLD. Also, patients with detected NAFLD were less likely than dyslipidemic patients without NAFLD to receive appropriate statin care (OR = 0.45, 95 % CI = 0.25–0.79).

Conclusion

Statins are underused in patients with NAFLD and dyslipidemia. The most important determinant for inappropriate statin use was PCP recognition of NAFLD. While these results need to be confirmed in non-VA healthcare systems, they highlight the need for efforts to enhance PCP knowledge of existing guidelines regarding statin use in NAFLD.

Access this article

Log in via an institution

Subscribe and save

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Dunn W, Xu R, Wingard DL, et al. Suspected nonalcoholic fatty liver disease and mortality risk in a population-based cohort study. Am J Gastroenterol. 2008;103:2263–2271.
    Article PubMed PubMed Central Google Scholar
  2. Corey KE, Chalasani N. Management of dyslipidemia as a cardiovascular risk factor in individuals with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2014;12:1077–1084.
    Article PubMed PubMed Central Google Scholar
  3. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012;142:1592–1609.
    Article PubMed Google Scholar
  4. Bays H, Cohen DE, Chalasani N, Harrison SA. An assessment by the Statin Liver Safety Task Force: 2014 update. J Clin Lipidol. 2014;8:247–257.
    Google Scholar
  5. Cohen DE, Anania FA, Chalasani N. National Lipid Association Statin Safety Task Force Liver Expert Panel. An assessment of statin safety by hepatologists. Am J Cardiol. 2006;97:77C–81C.
    Article CAS PubMed Google Scholar
  6. Chatrath H, Vuppalanchi R, Chalasani N. Dyslipidemia in patients with nonalcoholic fatty liver disease. Semin Liver Dis. 2012;32:22–29.
    Article CAS PubMed PubMed Central Google Scholar
  7. Kumar S, Grace ND, Qamar AA. Statin use in patients with cirrhosis: a retrospective cohort study. Dig Dis Sci. 2014;59:1958–1965.
    Article CAS PubMed Google Scholar
  8. Chalasani N. Statins and hepatotoxicity: focus on patients with fatty liver. Hepatology. 2005;41:690–695.
    Article CAS PubMed Google Scholar
  9. Chalasani N, Aljadhey H, Kesterson J, Murray MD, Hall SD. Patients with elevated liver enzymes are not at higher risk for statin hepatotoxicity. Gastroenterology. 2004;126:1287–1292.
    Article CAS PubMed Google Scholar
  10. Ekstedt M, Franzen LE, Mathiesen UL, Holmqvist M, Bodemar G, Kechagias S. Statins in non-alcoholic fatty liver disease and chronically elevated liver enzymes: a histopathological follow-up study. J Hepatol. 2007;47:135–141.
    Article CAS PubMed Google Scholar
  11. Calderon RM, Cubeddu LX, Goldberg RB, Schiff ER. Statins in the treatment of dyslipidemia in the presence of elevated liver aminotransferase levels: a therapeutic dilemma. Mayo Clin Proc. 2010;85:349–356.
    Article PubMed PubMed Central Google Scholar
  12. Blais P, Husain N, Kramer JR, Kowalkowski M, El-Serag H, Kanwal F. Nonalcoholic fatty liver disease is underrecognized in the primary care setting. Am J Gastroenterol. 2014. doi:10.1038/ajg.2014.134.
    PubMed Google Scholar
  13. Husain N, Blais P, Kramer J, et al. Nonalcoholic fatty liver disease (NAFLD) in the Veterans Administration population: development and validation of an algorithm for NAFLD using automated data. Aliment Pharmacol Ther. 2014;40:949–954.
    Article CAS PubMed Google Scholar
  14. Grundy SM, Becker D, Clark LT, et al. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation. 2002;106:3143–3421.
    Article Google Scholar
  15. US Food and Drug Administration. FDA Safety Communication: important safety label changes to cholesterol-lowering statin drugs. http://www.fda.gov/drugs/drugsafety/ucm293101.htm. Accessed August 5, 2014.
  16. Foster T, Budoff MJ, Saab S, Ahmadi N, Gordon C, Guerci AD. Atorvastatin and antioxidants for the treatment of nonalcoholic fatty liver disease: the St Francis Heart Study randomized clinical trial. Am J Gastroenterol. 2011;106:71–77.
    Article CAS PubMed Google Scholar
  17. Athyros VG, Tziomalos K, Gossios TD, et al. Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post hoc analysis. Lancet. 2010;376:1916–1922.
    Article CAS PubMed Google Scholar
  18. Nelson A, Torres DM, Morgan AE, Fincke C, Harrison SA. A pilot study using simvastatin in the treatment of nonalcoholic steatohepatitis: a randomized placebo-controlled trial. J Clin Gastroenterol. 2009;43:990–994.
    Article CAS PubMed Google Scholar
  19. Abraldes JG, Albillos A, Banares R, et al. Simvastatin lowers portal pressure in patients with cirrhosis and portal hypertension: a randomized controlled trial. Gastroenterology. 2009;136:1651–1658.
    Article CAS PubMed Google Scholar
  20. Mittal S, El-Serag HB, Sada YH, et al. Hepatocellular carcinoma in the absence of cirrhosis in United States veterans is associated with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2015. doi:10.1016/j.cgh.2015.07.019.
    PubMed Central Google Scholar

Download references

Acknowledgments

This work is funded in part by the Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413). Dr. El-Serag is also supported by National Institute of Diabetes and Digestive and Kidney Diseases K24-04-107.

Author information

Authors and Affiliations

  1. Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
    Pierre Blais, Michael Lin, Jennifer R. Kramer, Hashem B. El-Serag & Fasiha Kanwal
  2. Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
    Michael Lin, Jennifer R. Kramer, Hashem B. El-Serag & Fasiha Kanwal
  3. 660 S Euclid Ave., PO Box 8124, St. Louis, MO, 63110, USA
    Pierre Blais

Authors

  1. Pierre Blais
  2. Michael Lin
  3. Jennifer R. Kramer
  4. Hashem B. El-Serag
  5. Fasiha Kanwal

Corresponding author

Correspondence toPierre Blais.

Ethics declarations

Conflict of interest

None.

Additional information

Disclaimer The opinions and assertions contained herein are the sole views of the authors and are not to be construed as official or as reflecting the views of the Department of Veterans Affairs.

Rights and permissions

About this article

Cite this article

Blais, P., Lin, M., Kramer, J.R. et al. Statins Are Underutilized in Patients with Nonalcoholic Fatty Liver Disease and Dyslipidemia.Dig Dis Sci 61, 1714–1720 (2016). https://doi.org/10.1007/s10620-015-4000-6

Download citation

Keywords