Statins in chronic liver disease and its complications: An umbrella review and meta-analysis of systematic reviews
Cattazzo F, Cinque F, Maria VD, Vicardi M, Mantovani A, Zoncapè M, Natola LA, Sacerdoti D, Lombardi R, Dalbeni A
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver · 0 citas
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Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2026-06-12 · Dig Liver Dis · vol. 58 · número 8 · págs. 1027–1036
- Editorial
- Elsevier BV
- Citado
- 1 cita · más que el 88% de estudios similares · 2.2× el promedio de su campo
- Referencias
- 41 trabajos
- Acceso
- Acceso abierto (revista híbrida) · CC-BY
- Áreas de investigación
- Liver Disease Diagnosis and Treatment · Liver Disease and Transplantation · Cancer, Lipids, and Metabolism
- Palabras clave
- statins, chronic liver disease, hepatoprotection, hepatocellular carcinoma, hepatic decompensation, all-cause mortality, Asian populations, observational evidence, umbrella review of systematic reviews, methodological quality of systematic reviews, cirrhosis complications, mortality reduction, hepatoprotective therapy
- MeSH
- humans, carcinoma, hepatocellular, liver neoplasms, liver diseases, chronic disease, hydroxymethylglutaryl-coa reductase inhibitors, systematic reviews as topic
10 autores
- Filippo Cattazzo🇮🇹University of Verona; Azienda Ospedaliera Universitaria Integrata Verona
- Felice Cinque🇮🇹University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
- Vincenzo di Maria🇮🇹University of Verona; Azienda Ospedaliera Universitaria Integrata Verona
- Marco Vicardi🇮🇹University of Verona; Azienda Ospedaliera Universitaria Integrata Verona
- Anna Mantovani🇮🇹University of Verona; Azienda Ospedaliera Universitaria Integrata Verona
- Mirko Zoncapè🇮🇹University of Verona; Azienda Ospedaliera Universitaria Integrata Verona
- Leonardo Antonio Natola🇮🇹University of Verona; Azienda Ospedaliera Universitaria Integrata Verona
- David Sacerdoti🇮🇹University of Verona
- Rosa Lombardi🇮🇹University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
- Andrea Dalbeni🇮🇹 · autor de correspondenciaUniversity of Verona; Azienda Ospedaliera Universitaria Integrata Verona
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background and aims
Statins have been proposed as hepatoprotective agents in chronic liver disease (CLD); however, evidence from existing systematic reviews-including observational studies and clinical trials-is inconsistent and affected by substantial overlap. We conducted an umbrella review to synthesize the available evidence on the associations between statin use and hepatological outcomes in CLD patients, while addressing study overlap.
Design
PubMed, EMBASE, and Cochrane Library were searched up to September 2025 for systematic reviews of statin therapy in CLD. Methodological quality was evaluated using AMSTAR-2. Study overlap was assessed using corrected covered area (CCA) and minimized via hierarchical exclusion prioritizing methodological quality, comprehensiveness, and recency. Random-effects meta-analyses with bias assessments were conducted.
Results
Of 850 records screened, 17 systematic reviews (229 unique studies; 10,515,877 participants from 34 countries) were included after overlap adjustment (CCA = 5.79%). Statin therapy was associated with 46% reduction in hepatocellular carcinoma (HCC) risk (HR 0.54, 95% CI 0.48-0.59; I² = 46.7%) and 46% reduction in hepatic decompensation (HR 0.54, 95% CI 0.49-0.59; I² = 0.1%); these estimates derive predominantly from observational studies and should be interpreted as associations rather than causal effects. Geographic heterogeneity was observed: Asian populations showed stronger benefits (HCC HR 0.49, 95% CI 0.45-0.53; I² = 0%) compared with Western populations (HCC HR 0.71, 95% CI 0.52-0.96; I² = 95.7%; p = 0.003). Statin use also associated with reduced all-cause mortality (HR 0.65, 95% CI 0.52-0.81), though with substantial heterogeneity (I² = 80%). In contrast, available RCT-based evidence does not consistently confirm these associations for decompensation or mortality outcomes.
Conclusions
Statin use is consistently associated with reduced HCC risk and hepatic decompensation in CLD patients, particularly in Asian populations, though these findings derive predominantly from observational evidence subject to potential confounding. These associations support the continued use of statins in patients with CLD and cardiovascular indications where these are otherwise indicated, with potential additive hepatoprotective effects. These results underscore the urgent need for adequately powered randomized trials to clarify the boundaries of safety and efficacy in this high-risk population.
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