P1798 - Prescription Pattern of Statins in Cirrhosis in Primary Care Physicians and Cardiologists: Results of a Hospital Survey

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Rahul Karna, MD

Maulana Azad Medical College
Pittsburgh, PA, United States

Rahul Karna, MD¹, Shifa Umar, MD¹, Abhishek Chaturvedi, MD², Srinivas Murali, MD¹, Tavankit Singh, MD³
¹Allegheny Health Network, Pittsburgh, PA; ²Virginia Commonwealth University Health System, Richmond, VA; ³Allegheny General Hospital, Pittsburgh, PA

Introduction: Statin therapy is used for both primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). With a concern for hepatotoxicity, there is a reluctance among practitioners to prescribe it in patients with cirrhosis despite AASLD recommending its use in patients with cirrhosis and numerous studies showing beneficial effects on liver related outcomes. We aim to assess the prescription patterns of statins in cirrhotics in primary care physicians (PCPs) and cardiologists via this survey.

Methods: A voluntary survey via surveymonkey.com containing 9 objective type questions were sent to 220 PCPs and 75 cardiologists within Allegheny Health Network. Survey results were collected and values were expressed as N (frequencies). Chi square test was used to compare the two groups. P value ≤ 0.05 was considered for statistical significance.

Results: Overall, 64/220 PCPs (29.1%) and 15/75 (20%) cardiologists completed the survey and were included for final analysis. The results of the survey has been described in Table 1. 10/79 (12.6%) respondents did not prescribe statins to compensated cirrhotics for 1º prevention of ASCVD. 68.5% (48/70) of prescribing practitioners preferred lower intensity of statins. Interestingly, 14.1% (9/64) PCPs avoided statins in compensated cirrhotics for 2º prevention of ASCVD as well. Even though 100% (15/15) cardiologists prescribed statins for 2º prevention of ASCVD in compensated cirrhotics, more than 50% cardiologists preferred lower intensity of statins. Cardiologists were significantly more likely to prescribe statins if cirrhosis was due to NAFLD than other causes (p=0.05). While 47 % (30/64) PCPs did not have a preference of type of statin, 40% (6/15) cardiologists preferred pravastatin. Only 5/64 (7.8%) PCPs considered statin for improving outcomes in cirrhosis without CV indications.

Discussion: Despite increasing evidence favouring use of statins in cirrhosis for improving portal hemodynamics, decreasing ascites, hepatic encephalopathy, incidence of hepatocellular carcinoma and overall decreasing 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.

Questionnaire	PCPs (N=64)	Cardiologist (N=15)	P value
Would you prescribe statins to a compensated cirrhotic for primary prevention of ASCVD?			0.93
No	8 (12.5%)	2 (13.3%)
Yes	56 (87.5%)	13 (86.7%)
If yes to above, would you prefer lower intensity of statins for primary prevention of ASCVD, if your patient had concomitant compensated non-NAFLD cirrhosis?			0.81
No	17 (26.6%)	5 (33.3%)
Yes	40 (62.5%)	8 (53.3%)
Not applicable	7 (10.9%)	2 (13.3%)
Would you prescribe statins to a compensated cirrhotic for secondary prevention of ASCVD?			0.12
No	9 (14.1%)	-
Yes	55 (85.9%)	15 (100%)
If yes to above, would you prefer lower intensity of statins for secondary prevention of ASCVD, if your patient had concomitant compensated non-NAFLD cirrhosis?			0.23
No	22 (34.4%)	8 (53.3%)
Yes	35 (54.7%)	7 (46.7%)
Not applicable	7 (10.9%)	-
Would you be more inclined to prescribing statins for primary or secondary prevention of ASCVD if cirrhosis is secondary to NAFLD rather than non-NAFLD?			0.05
No	35 (54.7%)	4 (26.7%)
Yes	29 (45.3%)	11 (73.3%)
Which statin would you prefer in cirrhotic with ASCVD?			0.18
Simvastatin	1 (1.6%)	1 (6.7%)
Atorvastatin	7 (10.9%)	1 (6.7%)
Pravastatin	10 (15.6%)	6 (40%)
Fluvastatin	0 (0%)	0 (0%)
Rosuvastatin	16 (25%)	3 (20%)
Doesn't matter	30 (46.9%)	4 (26.7%)
Would you have a lower threshold to stop statins in patients with liver enzyme elevation, if they had concomitant cirrhosis?			0.56
No	9 (14.1%)	3 (20%)
Yes	55 (85.9%)	12 (80%)
In patients with newly diagnosed cirrhosis, do you consider starting statins if not needed from cardiovascular standpoint?			0.26
No	59 (92.2%)	15 (100%)
Yes	5 (7.8%)	-

Table: Title: Comparison of statin prescription in cirrhosis patients between primary care physicians and cardiologists (Nf79)
Abbreviations: PCPs: primary care physicians, ASCVD: atherosclerotic cardiovascular disease, NAFLD: non-alcoholic fatty liver disease

Disclosures:

Rahul Karna indicated no relevant financial relationships.

Shifa Umar indicated no relevant financial relationships.

Abhishek Chaturvedi indicated no relevant financial relationships.

Srinivas Murali indicated no relevant financial relationships.

Tavankit Singh indicated no relevant financial relationships.

Rahul Karna, MD¹, Shifa Umar, MD¹, Abhishek Chaturvedi, MD², Srinivas Murali, MD¹, Tavankit Singh, MD³. P1798 - Prescription Pattern of Statins in Cirrhosis in Primary Care Physicians and Cardiologists: Results of a Hospital Survey, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.