Annals of hepatology · 2026
Impact of adding statins to non-selective beta-blockers in cirrhosis with portal hypertension: a systematic review and meta-analysis of randomized controlled trials.
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Wu Qingping, Yang Yifei, Wu Qi, Wu Yue, Liu Shan
Аннотация
INTRODUCTION AND OBJECTIVES: Despite non-selective beta-blockers (NSBBs), patients with cirrhosis and portal hypertension (PH) remain at substantial risk of death. Statins may improve intrahepatic microcirculation and potentially complement NSBB effects.
MATERIALS AND METHODS: We searched PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov from inception to October 2025 for randomized controlled trials (RCTs) comparing NSBB-based therapy plus statins versus NSBB-based therapy alone. Rare events were synthesized using fixed-effect Peto odds ratios; other outcomes were pooled with random-effects models, with prediction intervals (PI) reported. Prespecified subgroup and sensitivity analyses were performed.
RESULTS: Seven RCTs (n = 954) were included. Statin add-on therapy was not clearly associated with fewer PH-related complications, including variceal bleeding (RR = 0.79, P = 0.10), new or worsening ascites (RR = 0.81, P = 0.13), or hepatic encephalopathy (RR = 0.41, P = 0.06). However, it was associated with a lower risk of all-cause mortality (RR = 0.46, 95% CI: 0.32-0.65, 95% PI: 0.28-0.76, P < 0.001, I2 = 0). Adding statins also resulted in greater hepatic venous pressure gradient (HVPG) reductions and a higher proportion of patients achieving a ≥ 20% HVPG decrease. Aches and transaminase elevations occurred more often with statins. In subgroup analyses, the mortality association was observed in Child-Pugh A/B patients.
CONCLUSIONS: In cirrhosis with PH, statin add-on therapy is associated with improved portal hemodynamics and lower all-cause mortality, whereas associations with PH-related complications remain uncertain.
PROSPERO REGISTRATION NUMBER: CRD420251172719.
MATERIALS AND METHODS: We searched PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov from inception to October 2025 for randomized controlled trials (RCTs) comparing NSBB-based therapy plus statins versus NSBB-based therapy alone. Rare events were synthesized using fixed-effect Peto odds ratios; other outcomes were pooled with random-effects models, with prediction intervals (PI) reported. Prespecified subgroup and sensitivity analyses were performed.
RESULTS: Seven RCTs (n = 954) were included. Statin add-on therapy was not clearly associated with fewer PH-related complications, including variceal bleeding (RR = 0.79, P = 0.10), new or worsening ascites (RR = 0.81, P = 0.13), or hepatic encephalopathy (RR = 0.41, P = 0.06). However, it was associated with a lower risk of all-cause mortality (RR = 0.46, 95% CI: 0.32-0.65, 95% PI: 0.28-0.76, P < 0.001, I2 = 0). Adding statins also resulted in greater hepatic venous pressure gradient (HVPG) reductions and a higher proportion of patients achieving a ≥ 20% HVPG decrease. Aches and transaminase elevations occurred more often with statins. In subgroup analyses, the mortality association was observed in Child-Pugh A/B patients.
CONCLUSIONS: In cirrhosis with PH, statin add-on therapy is associated with improved portal hemodynamics and lower all-cause mortality, whereas associations with PH-related complications remain uncertain.
PROSPERO REGISTRATION NUMBER: CRD420251172719.