Systematic review with a meta-analysis: clinical effects of statins on the reduction of portal hypertension and variceal haemorrhage in cirrhotic patients - PubMed (original) (raw)

Meta-Analysis

Systematic review with a meta-analysis: clinical effects of statins on the reduction of portal hypertension and variceal haemorrhage in cirrhotic patients

Sizhe Wan et al. BMJ Open. 2019.

Abstract

Background: Statins may improve outcomes in patients with cirrhosis. We performed a systematic review and meta-analysis to evaluate the effect of statins on patients with cirrhosis and related complications, especially portal hypertension and variceal haemorrhage.

Methods: Studies were searched in the PubMed, Embase and Cochrane library databases up to February 2019. The outcomes of interest were associations between statin use and improvement in portal hypertension (reduction >20% of baseline or <12 mm Hg) and the risk of variceal haemorrhage. The relative risk (RR) with a 95% CI was pooled and calculated using a random effects model. Subgroup analyses were performed based on the characteristics of the studies.

Results: Eight studies (seven randomised controlled trials (RCTs) and one observational study) with 3195 patients were included. The pooled RR for reduction in portal hypertension was 1.91 (95% CI, 1.04 to 3.52; I2=63%) in six RCTs. On subgroup analysis of studies that used statin for 1 month, the RR was 2.01 (95% CI, 1.31 to 3.10; I2=0%); the pooled RR for studies that used statins for 3 months was 3.76 (95% CI, 0.36 to 39.77; I2=75%); the pooled RR for studies that used non-selective beta-blockers in the control group was 1.42 (95% CI, 0.82 to 2.45; I2=64%); the pooled RR for studies that used a drug that was not reported in the control group was 4.21 (95% CI, 1.52 to 11.70; I2=0%); the pooled RR for studies that used simvastatin was 2.20 (95% CI, 0.92 to 5.29; I2=69%); RR for study using atorvastatin was 1.82 (95% CI, 1.00 to 3.30). For the risk of a variceal haemorrhage, the RR based on an observational study was 0.47 (95% CI, 0.23 to 0.94); in two RCTs, the pooled RR was 0.88 (95% CI, 0.52 to 1.50; I2=0%). Overall, the summed RR was 0.64 (95% CI, 0.42 to 0.99; I2=6%).

Conclusion: Statins may improve hypertension and decrease the risk of variceal haemorrhage according to our assessment. However, further and larger RCTs are needed to confirm this conclusion.

Keywords: cirrhotic; meta-analysis; portal hypertension; statins; variceal haemorrhage.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart.

Figure 2

Figure 2

Risk of bias assessed using the Cochrane risk of bias tool for randomised controlled trials.

Figure 3

Figure 3

Forest plot using the Mantel-Haenszel (M-H) analysis method to evaluate the role of statins in the reduction of portal hypertension using a subgroup analysis based on medication time of statins.

Figure 4

Figure 4

Forest plot using the Mantel-Haenszel (M-H) analysis method to evaluate the role of statins in the reduction of portal hypertension using subgroup analysis based on the types of drugs in the control group. NSBB, non-selective beta-blockers.

Figure 5

Figure 5

Forest plot using the Mantel-Haenszel (M-H) analysis method to evaluate the role of statins in the reduction of portal hypertension using subgroup analysis based on types of statins.

Figure 6

Figure 6

Forest plot using the Mantel-Haenszel (M-H) analysis method to evaluate the role of statins in the reduction of the risk of variceal haemorrhage using subgroup analysis based on types of statins.

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