BACKGROUND AND AIM.
Statins are commonly used medications for the treatment of
dyslipidemia. Although there are reported cases of hepatotoxicity related to
statins, very few are associated with severe course and
liver failure. MATERIAL AND METHODS. We used the Third National Health and Nutrition Examination Survey (NHANES III)-mortality linked files to assess the association between
statin use and liver-related mortality. Patients with established causes of
liver disease (HCV
RNA-positive, HBs-Ag-positive,
NAFLD by hepatic ultrasound,
iron overload and excessive alcohol use of > 20 g of alcohol per day with elevated liver
enzymes) were excluded. RESULTS. Of all adult NHANES III participants enrolled in 1988-1994 (n = 20,050), 9,207 individuals had sufficient demographic, clinical and medical information making them eligible for this study (age 41.26 ± 0.38, 46.76% male, 76.67% Caucasian, BMI 26.39 ± 0.38, 16.99% had diabetes or
insulin resistance, 16.97% had
hypertension, 65.28% had
dyslipidemia). Of the entire study cohort, 90 (1.25%) participants reported using
statins at the time of the interview. Median mortality follow-up for the study cohort was 175.54 months. During this period, 1,330 individuals (11.25%) died with 26 (0.17%) being liver-related deaths. For the cohort using
statins, there were 37 deaths (40.15%) after a median follow-up of 143.35 months. In fact, the top cause of death for
statin users was cardiac related (16 cases, 33.62%). However, after adjusting for major demographic, clinical and metabolic confounders,
statin use was not associated with cardiovascular deaths in males (Hazard Ratio, 0.79, 95% Confidence Interval, 0.30-2.13), but was associated with higher risk of cardiovascular deaths in females (odds ratio, 2.32, 95% confidence interval, 1.58-3.40). Furthermore, the rate of liver-related mortality was significantly lower (p = 0.0035) among
statin users compared to non-
statin users. CONCLUSIONS. After a decade of follow up, there was no association between
statin use and liver-related mortality.