Statin Therapy Improves Sustained Virologic Response Among Diabetic Patients With Chronic Hepatitis C

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http://www.gastrojournal.org/article/PIIS0016508510013077/abstract?rss=yes

Gastroenterology

Volume 140, Issue 1 , Pages 144-152.e2, January 2011

Statin Therapy Improves Sustained Virologic Response Among Diabetic Patients

With Chronic Hepatitis C

Gowtham A. Rao

AffiliationsKansas City Veterans Affairs Medical Center, Kansas City,

MissouriArnold School of Public Health, University of South Carolina, Columbia,

South Carolina

, Prashant K. Pandya

Affiliations

Kansas City Veterans Affairs Medical Center, Kansas City, MissouriKansas

University Medical Center, Kansas City, KansasReprint requests Address requests

for reprints to: Prashant K. Pandya, DO, 4801 E. Linwood Blvd, Kansas City,

Missouri 64128. fax: (816) 922-4692

Received 24 February 2010; accepted 24 August 2010. published online 13

September 2010.

Abstract

Background & Aims

Patients with chronic hepatitis C infection are 2- to 3-fold more likely to

develop type 2 diabetes, which reduces their chances of achieving a sustained

virologic response (SVR). To identify differences in predictors of SVR in

patients with and without diabetes who received combination antiviral therapy,

we conducted a retrospective analysis of a national Veterans Affairs

administrative database.

Methods

We analyzed data from the Veterans Affairs Medical SAS Datasets and Decision

Support System for entire cohort and separately for diabetic patients (n = 1704)

and nondiabetic patients (n = 6589). Significant predictors of SVR were

identified by logistic regression analysis.

Results

Diabetic patients had a lower SVR compared with nondiabetic patients (21% vs

27%, respectively, P < .001). Diabetic patients had higher clustering of

previously established negative predictors of SVR. On multivariate analysis of

diabetic patients for SVR, the positive predictors were higher low-density

lipoprotein (odds ratio [OR], 1.45; P = .0129), use of statin (OR, 1.52; P =

..0124), and lower baseline viral load (OR, 2.31; P < .001), whereas insulin

therapy (OR, 0.7; P = .0278) was a negative predictor. Diabetic patients on

statins had higher pretreatment viral loads (log 6.2 vs 6.4, respectively, P =

..006) but better early virologic response. There was a graded inverse

relationship between Hemoglobin A1c and SVR rate (P = .0482). This relationship

was significant among insulin users (P = .0154) and non-significant among

metformin users (P = .5853).

Conclusions

Statin use was associated with an improved SVR among both diabetic patients and

nondiabetic patients receiving combination antiviral therapy. Diabetic patients

who received insulin achieved lower SVR compared with those not receiving

insulin. Poor diabetes control was associated with lower SVR rates.

Conflicts of interestThe authors disclose no conflicts.

Funding Supported with resources and the use of the Kansas City VA Medical

Center facility.

The views expressed in this article are those of the authors and do not

necessarily reflect the position or policy of the Department of Veterans Affairs

or the United States government.

PII: S0016-5085(10)01307-7

doi:10.1053/j.gastro.2010.08.055

© 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.