Butt Muhammad Ali, Karna Rahul, Umar Shifa, Chaturvedi Abhishek, Murali Srinivas, Singh Tavankit
Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
Proc (Bayl Univ Med Cent). 2024 Jul 8;37(5):769-773. doi: 10.1080/08998280.2024.2372753. eCollection 2024.
Statin therapy is widely utilized for preventing atherosclerotic cardiovascular disease, both as a primary and secondary measure. Despite the American Association for the Study of Liver Diseases' endorsement of statin use in cirrhotic patients, practitioners exhibit hesitancy, primarily due to concerns regarding hepatotoxicity. This study aimed to evaluate statin prescription patterns in cirrhotic patients by primary care physicians (PCPs) and cardiologists through a survey.
A voluntary survey via Survey Monkey with nine objective-type questions was sent to 220 PCPs and 75 cardiologists within Allegheny Health Network. Survey results were collected, and a chi square test was used to compare the two groups. A value ≤ 0.05 was considered statistically significant.
A total of 64 PCPs (29.1%) and 15 cardiologists (20%) completed the survey. Overall, 12.6% did not prescribe statins for primary prevention of atherosclerotic cardiovascular disease in compensated cirrhotic patients. While all cardiologists prescribed statins for secondary prevention, over 50% preferred lower-intensity options. Conversely, 14.1% of PCPs avoided statin prescriptions for secondary prevention. Cardiologists were significantly more inclined to prescribe statins, especially for cirrhosis due to metabolic dysfunction-associated steatotic liver disease compared to PCPs (73.3% vs 45.3%, = 0.05).
Despite increasing evidence favoring use of statins in cirrhosis for improving portal hemodynamics and decreasing ascites, hepatic encephalopathy, the incidence of hepatocellular carcinoma, and mortality, there is still hesitation on the part of prescribers for the fear of worsening liver disease. Wider dissemination of current guidelines and education practices may help to bridge this gap.
他汀类药物治疗作为一级和二级预防措施，被广泛用于预防动脉粥样硬化性心血管疾病。尽管美国肝病研究协会认可在肝硬化患者中使用他汀类药物，但从业者仍表现出犹豫，主要是因为担心肝毒性。本研究旨在通过一项调查评估初级保健医生（PCP）和心脏病专家对肝硬化患者的他汀类药物处方模式。
通过Survey Monkey向阿勒格尼健康网络内的220名初级保健医生和75名心脏病专家发送了一份包含9个客观类型问题的自愿调查问卷。收集调查结果，并使用卡方检验比较两组。P值≤0.05被认为具有统计学意义。
共有64名初级保健医生（29.1%）和15名心脏病专家（20%）完成了调查。总体而言，12.6%的医生未为代偿期肝硬化患者的动脉粥样硬化性心血管疾病一级预防开具他汀类药物。虽然所有心脏病专家都为二级预防开具他汀类药物，但超过50%的人更喜欢低强度方案。相反，14.1%的初级保健医生避免为二级预防开具他汀类药物处方。与初级保健医生相比，心脏病专家明显更倾向于开具他汀类药物，尤其是对于代谢功能障碍相关脂肪性肝病导致的肝硬化（73.3%对45.3%，P = 0.05）。
尽管越来越多的证据支持在肝硬化中使用他汀类药物以改善门静脉血流动力学、减少腹水、肝性脑病、肝细胞癌发病率和死亡率，但由于担心加重肝病，处方者仍有所犹豫。更广泛地传播当前指南和教育实践可能有助于弥合这一差距。
