Real-World Risk and Outcome of Liver Cirrhosis in Patients with Hyperlipidemia Treated with Red Yeast Rice: A Retrospective Cohort Study

Abstract

Chuen-Chau Chang,1– 3,* Chun-Chieh Yeh,4,5 Cheng Tiong,6,7 Mao-Feng Sun,8 Jaung-Geng Lin,8 Yih-Giun Cherng,3,9 Ta-Liang Chen,2,3,10,* Chien-Chang Liao1– 3,8,11 1Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; 2Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; 3Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 4Department of Surgery, China Medical University Hospital, Taichung, Taiwan; 5Department of Surgery, University of Illinois, Chicago, IL, USA; 6Division of Gastroenterology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; 7Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 8School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 9Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; 10Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 11Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan*These authors contributed equally to this workCorrespondence: Chien-Chang Liao, Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St, Taipei, 110, Taiwan, Email [email protected]; [email protected]: Sustained hyperlipidemia contributes to fatty liver and liver cirrhosis. Red yeast rice (RYR) effectively improved the lipid profile; however, the effects of RYR on the risk of incident liver cirrhosis remain to be elucidated. We aimed to evaluate the beneficial effects of RYR use on the risk and outcome of liver cirrhosis.Patients and methods: We identified 156,587 adults who had newly diagnosed hyperlipidemia in 2010– 2016 from health insurance data in this retrospective cohort study. Using propensity score matching, we selected 34,367 patients who used RYR and 34,367 patients who used lovastatin. Events of incident liver cirrhosis that occurred in the two cohorts during the follow-up period of 2010– 2019 were identified. We calculated adjusted hazard ratios (HRs) and 95% confidence intervals (Cis) for liver cirrhosis risk associated with RYR use in the multiple Cox proportional hazard model.Results: Compared with patients who used lovastatin, patients who used RYR had a decreased risk of liver cirrhosis (HR 0.60, 95% CI 0.57– 0.63), and this association was significant in various subgroups. A biological gradient relationship between the frequency of RYR use and decreased liver cirrhosis was observed (p for trend < 0.0001). Reduced postcirrhosis jaundice (HR 0.56, 95% CI 0.43– 0.72), ascites (HR 0.37, 95% CI 0.28– 0.50), hepatic coma (HR 0.36, 95% CI 0.26– 0.50), and mortality (HR 0.48, 95% CI 0.38– 0.61) were also associated with RYR use.Conclusion: We demonstrated the beneficial effects of RYR use on the risk and outcome of liver cirrhosis; however, the lack of compliance data should be considered. However, our study did not infer causality or claim the superiority of RYR over lovastatin.Keywords: hyperlipidemia, liver cirrhosis, lovastatin, outcome, red yeast rice, risk

Keywords

• hyperlipidemia
• liver cirrhosis
• lovastatin
• outcome
• red yeast rice
• risk