Schreiner Andrew D, Zhang Jingwen, Petz Chelsey A, Moran William P, Koch David G, Marsden Justin, Bays Chloe, Mauldin Patrick D, Gebregziabher Mulugeta
Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
BMJ Open Gastroenterol. 2024 Jul 17;11(1):e001404. doi: 10.1136/bmjgast-2024-001404.
We aimed to determine the association of statins with progression to a high risk for advanced fibrosis in primary care patients with metabolic dysfunction-associated steatotic liver disease (MASLD).
This retrospective cohort study of electronic health record data included patients with MASLD and an initial low or indeterminate risk for advanced fibrosis, determined by Fibrosis-4 Index (FIB-4) score (<2.67). Patients were followed from the index FIB-4 until the primary outcome of a high-risk FIB-4 (≥2.67) or the end of the study period. Prescription for a statin during follow-up was the primary exposure. We developed Cox regression models for the time to a high-risk FIB-4 score with statin therapy as the primary covariate and adjusting for baseline fibrosis risk, demographic and comorbidity variables.
The cohort of 1238 patients with MASLD was followed for a mean of 3.3 years, with 47% of patients receiving a prescription for a statin, and 18% of patients progressing to a high-risk FIB-4. In the adjusted Cox model with statin prescription as the primary exposure, statins were associated with a lower risk (HR 0.60; 95% CI 0.45 to 0.80) of progressing to a FIB-4≥2.67. In the adjusted Cox models with statin prescription intensity as the exposure, moderate (HR 0.60; 95% CI 0.42 to 0.84) and high intensity (HR 0.61; 95% CI 0.42 to 0.88) statins were associated with a lower risk of progressing to a high-risk FIB-4.
Statin prescriptions, and specifically moderate and high intensity statin prescriptions, demonstrate a protective association with fibrosis risk progression in primary care patients with MASLD.
我们旨在确定在患有代谢功能障碍相关脂肪性肝病（MASLD）的基层医疗患者中，他汀类药物与进展为晚期肝纤维化高风险之间的关联。
这项对电子健康记录数据的回顾性队列研究纳入了患有MASLD且根据纤维化-4指数（FIB-4）评分（<2.67）确定初始晚期肝纤维化风险较低或不确定的患者。从索引FIB-4开始对患者进行随访，直至出现高风险FIB-4（≥2.67）这一主要结局或研究期结束。随访期间他汀类药物的处方是主要暴露因素。我们建立了Cox回归模型，以他汀类药物治疗作为主要协变量，并对基线纤维化风险、人口统计学和合并症变量进行调整，来分析达到高风险FIB-4评分的时间。
1238例MASLD患者队列的平均随访时间为3.3年，47%的患者接受了他汀类药物处方，18%的患者进展为高风险FIB-4。在以他汀类药物处方作为主要暴露因素的校正Cox模型中，他汀类药物与进展为FIB-4≥2.67的较低风险相关（风险比[HR] 0.60；95%置信区间[CI] 0.45至0.80）。在以他汀类药物处方强度作为暴露因素的校正Cox模型中，中强度（HR 0.60；95% CI 0.42至0.84）和高强度（HR 0.61；95% CI 0.42至0.88）他汀类药物与进展为高风险FIB-4的较低风险相关。
他汀类药物处方，特别是中强度和高强度他汀类药物处方，在患有MASLD的基层医疗患者中显示出与纤维化风险进展的保护性关联。
