Hepatic Effects of Lovastatin Exposure in Patients with Differing Types of Liver Disease

Abstract

Purpose: We previously reported that exposure to lovastatin (lova) was associated w/a significant reduction in a variety of adverse liver-disease (LD) outcomes in patients (pts) w/existing LD. Here we examined if these effects were consistent across a spectrum of baseline LD disorders. Methods: This retrospective cohort study used data from 1995 through mid-2005. Adult members of KP were identified who had at least 2 elevated ALT or AST tests w/in a 6- to-18 month period, evidence of chronic viral hepatitis, or carried a LD diagnosis. Lova use was gathered from pharmacy databases. The outcome was the 1st occurrence of a new ALT level that was at least 3 x ULN(or 3 x baseline value if elevated), or a new diagnosis of cirrhosis or liver failure. Pts were hierarchically classified into 1 of 5 groups based on criteria for entry to the analytic cohort: chronic viral hepatitis, alcoholic LD, fatty LD, all other LD diagnoses, & those w/elevated liver tests (LTs). Incidence rates of outcomes were calculated w/in baseline LD groups; incidence rate ratios were calculated as the incidence rate during lova-exposed periods divided by the rate during lova-unexposed periods. Multivariate analyses were conducted w/extended Cox models adjusting for age & gender. Results: A total of 73232 pts met the entry criteria and were at risk for an outcome event. Overall, lova exposure was associated w/a lower risk of each outcome that was consistent across all baseline LD subsets(Table). All reductions were significant except fatty liver, likely due to the small number of cases (3 exposed, 76 unexposed); these results persisted after multivariate adjustment.TableConclusions: Lova exposure was associated w/a significantly lower risk of adverse LD outcomes; this effect was apparent in all baseline LD subgroups, though not all effects retained significance in stratified analyses.