Originally published by our sister publication Gastroenterology & Endoscopy News
By Angely Mercado
Post–myocardial infarction patients are less likely to receive statins as part of their treatment if they live with alcohol-associated liver disease, according to a new analysis presented at The Liver Meeting 2023.
The researchers also found that patients with ALD are less likely to receive other secondary preventive medications, such as beta-blockers.
For patients with ALD who received statins, the researchers found a lower mortality rate, suggesting that failure to receive statins negatively affects patient outcomes.
Drawing data from Swedish national healthcare registers, primary investigator Axel Wester, MD, PhD, an assistant professor at the Karolinska Institutet in Huddinge, Sweden, and his co-investigators analyzed patients with ALD who experienced a first-time MI between 2006 and 2020. The median age of the patients was 68 years and the majority (75%) identified as male. The analysis looked at prescriptions filled for four secondary prevention drugs: antiplatelets, statins, beta-blockers and renin–angiotensin inhibitors.
Prescriptions of these secondary prevention drugs were less common in patients with ALD. compared with the general population (39% vs. 67%, respectively; P<0.001; adjusted odds ratio [aOR], 0.30; 95% CI, 0.23-0.38).
The largest difference was noticed in prescriptions for statins. About 62% of patients with ALD were prescribed statins compared with 92% of those without ALD (P<0.001; aOR, 0.17; 95% CI, 0.13-0.22).
The researchers also found that among patients taking one of the four preventive medications, fewer patients were taking medications for MI two years after the cardiac event if they had ALD compared with those who did not (52% vs. 62%; P=0.045).
During a median follow-up of 2.6 years, the researchers found a higher mortality rate for patients who had not initiated statins compared with those who had started the therapy (77.2% vs. 47.3%; adjusted hazard ratio, 0.51; 95% CI, 0.38-0.68).
Some clinicians may be “afraid of prescribing statins to people with liver disease, and that is why they get them less often,” Dr. Wester said.
Camille A. Kezer, MD, a gastroenterology and hepatology fellow at Mayo Clinic in Rochester, Minn., agreed that clinicians may be afraid to worsen a patient’s health, especially if they are at risk for liver injury. “For the majority of patients, transaminases will normalize with ongoing statin therapy or drug discontinuation. Severe liver injury is uncommon,” she told Gastroenterology & Endoscopy News. “Nevertheless, this may make providers less comfortable prescribing statins in the setting of liver disease given this association.”
Aasma Shaukat, MD, MPH, a gastroenterologist and the director of outcomes research in the Division of Gastroenterology and Hepatology at NYU Langone Health, in New York City, said statins often lead to better health outcomes after an MI.
“Statins [are] associated with lower risk of dying from cardiovascular causes and other causes, and that’s a universal recommendation in the cardiology literature,” Dr. Shaukat said, noting that the concern for an uncommon side effect is depriving ALD patients from access to medication. “Prescribe patients what they need. Alcohol-associated liver disease is not a contradiction. If there is concern, then [the patient] could be appropriately referred to a gastroenterologist or other specialists, but we shouldn’t stop therapy.”
Dr. Wester explained that he could not completely confirm from his analysis that MI patients with ALD are purposely not being prescribed statins as part of their long-term treatment. “Another explanation could be that the drugs are prescribed, but those with ALD do not collect them from pharmacies as often as the general population,” he said.
More data are needed, he said, to understand why statins were less likely to be used long term for MI patients living with ALD.
Drs. Kezer, Shaukat and Wester reported no relevant financial disclosures.