Effect of Stains on LDL Reduction and Liver Safety: A Systematic Review and Meta-Analysis

Background and Aim. Statin is a class of medications used to decrease low-density lipoprotein cholesterol level to prevent cardiovascular disease. However, the risk of hepatic damage caused by statin therapy is still controversial. We conducted a systematic review and meta-analysis summarizing the existing evidence of the effect of statin therapy on incidence of liver injury to clarify whether statin therapy could lead to liver function test abnormalities. Methods. We searched the Cochrane Library, PubMed, and Embase database for the relevant studies update till Jan. 2017 regarding statin therapy and liver injury. Two researchers screened the literature independently by the selection and exclusion criteria. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using random effects models, and subgroup analyses were performed by study characteristics. This meta-analysis was performed by STATA 13.1 software. Results. Analyses were based on 74,078 individuals from 16 studies. The summary OR of statin therapy was 1.18 (95% CI: 1.01-1.39, p = 0.04; I-2 = 0.0%) for liver injury. Subgroup analysis indicated that fluvastatin increased the risk of liver injury significantly (OR, 3.50; 95% CI: 1.07-11.53, p = 0.039; I-2 = 0.0%) and dose over 40mg/ daily had an unfavorable effect on the liver damage (OR, 3.62; 95% CI: 1.52-8.65, p = 0.004; I-2 = 0.0%). The sensitivity analysis indicated that the results were robust. Conclusion. Our findings confirm that statin therapy substantially increases the risk of liver injury, especially using fluvastatin over 40mg/d.