Impact of adding statins to non-selective beta-blockers in cirrhosis with portal hypertension: a systematic review and meta-analysis of randomized controlled trials
In brief
Adding statins to beta-blocker therapy cuts all-cause death by about half in cirrhosis
A meta-analysis of seven trials involving 954 patients found that statin add-on reduced overall mortality by roughly 50% compared with beta-blockers alone, while showing no clear benefit for variceal bleeding, ascites, or encephalopathy. The mortality gain was linked to greater portal pressure drops but came with more muscle aches and liver-enzyme elevations, especially in patients with less advanced disease.
- Journal
- Annals of hepatology (Q1)
- Published
- 19 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Qingping Wu, Yifei Yang, Qi Wu, Yue Wu, Shan Liu
- PMID
- 42472575
- DOI
- 10.1016/j.aohep.2026.102259
Why clinicians should know about it
- Picked for Hepatology (top studies of the week, 26 July 2026).
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.