Original Research

Atorvastatin as Adjunctive Therapy in Hepatitis C-Induced Cirrhosis: Impact on Portal Hypertension via Doppler Damping Index

Muhammad Kamran1
Pak Red Crescent Medical College, DinaNath
Ali Asad Khan2
Narowal Medical College, Narowal
Muhammad Arshad Khan3
Rahbar College of Dentistry, Lahore
Bilal Aziz4
King Edward Medical University Lahore
Tazeen Nazar4
King Edward Medical University Lahore
Nouman Hameed5
Mayo Hospital Lahore

✉ Correspondence: Ali Asad Khan Email: asad.kemcolian@yahoo.com

DOI https://doi.org/10.70302/jpsim.v7i1.2607
Volume: 7, Issue 1 Pages: 33–37 Published: 10 Mar 2026
Received: 23 Oct 2025 Revised: 12 Jan 2026 Accepted: 17 Feb 2026 Published Online: 10 Mar 2026

Abstract

Objective

To evaluate the effectiveness of adding atorvastatin to non-selective beta-blocker (NSBB) therapy to reduce portal hypertension, as measured by the damping index, in patients with hepatitis C virus (HCV)-related liver cirrhosis over a three-month period.

Methodology

This randomized controlled trial was conducted over six months, from February 21, 2022 to August 20, 2022. A total of 70 patients with HCV-related cirrhosis who met the inclusion criteria were enrolled and randomly assigned into two equal groups (n = 35). Group A received carvedilol in combination with atorvastatin 20 mg once daily at night, while Group B was treated with carvedilol alone. All participants were followed for a duration of three months. Portal hypertension was assessed non-invasively using Doppler ultrasound, with measurements focused on portal vein diameter (PVD) and hepatic vein damping index (DI) as surrogate markers of portal pressure.

Results

The mean age was 47 ± 10.46 years in Group A and 49 ± 9.91 years in Group B. Baseline PVD was 16 ± 1.72 mm in Group A and 16 ± 1.99 mm in Group B. After three months, PVD decreased to 12 ± 2.17 mm in Group A and 14 ± 1.79 mm in Group B (p = 0.000). The mean DI at baseline was 0.83 ± 0.12 in Group A and 0.85 ± 0.13 in Group B, which decreased to 0.50 ± 0.05 and 0.70 ± 0.04, respectively (p = 0.047).

Conclusion

The addition of atorvastatin to NSBB therapy significantly reduced portal hypertension—as reflected by both portal vein diameter and damping index—compared to NSBB alone in patients with HCV-induced cirrhosis.

Keywords
Atorvastatin Cirrhosis Portal hypertension Damping index.

How to Cite This Article

Kamran M, Khan AA, Khan MA, Aziz B, Nazar T, Hameed N. Atorvastatin as Adjunctive Therapy in Hepatitis C-Induced Cirrhosis: Impact on Portal Hypertension via Doppler Damping Index. J Pak Soc Intern Med. 2026;7(1):33–37. doi:10.70302/jpsim.v7i1.2607

⭳ Download XML (JATS) ⭳ Download PDF

Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

Data Availability

Data are available from the corresponding author on reasonable request.

Ethics Statement

This study was approved by Institutional Review Board, King Edward Medical University, Lahore, Pakistan. Approval number: 5233/REG/KEMU/22, dated February 04, 2022.

Conducted in accordance with the Declaration of Helsinki.

References

  1. Tantai X, Wang Y, Dong Q. Risk factors and outcomes of variceal bleeding in cirrhosis: A multicenter prospective study. J Hepatol. 2021;75(2):299–307.
  2. Bosch J, Abraldes JG, Berzigotti A, García-Pagán JC. The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol. 2009;6(10):573-82.
  3. Wan S, Huang C, Zhu X. Systematic review with a meta-analysis: clinical effects of statins on the reduction of portal hypertension and variceal haemorrhage in cirrhotic patients. BMJ open. 2019;9(7):e030038.
  4. Kim RG, Loomba R, Prokop LJ, Singh S. Statins and portal hypertension: A systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2020;18(8):1741–52.
  5. Krawczyk M, Bonfrate L, Portincasa P. Statins in liver disease: Evidence and challenges. J Clin Med. 2022;11(1):182.
  6. Villanueva C, Albillos A, Genescà J, Garcia-Pagán JC, Calleja JL, Aracil C, et al. β-blocker failure in patients with advanced cirrhosis: A multicenter prospective study. Hepatology. 2022;75(4):1051–63.
  7. Suk KT. Hepatic venous pressure gradient: clinical use in chronic liver disease. Clinical and molecular hepatology. 2014;20(1):6-14.
  8. Trebicka J. Statins and cirrhosis: More than lipid lowering. Hepatol Int. 2020;14(3):474–85.
  9. Krawczyk M, Bonfrate L, Portincasa P. Statins in liver disease: Evidence and challenges. J Clin Med. 2022;11(1):182-90.
  10. Pelusi S, Tovoli F, Casadei-Gardini A, Ravaioli F, Conti F. Pleiotropic effects of statins in liver disease. Eur J Intern Med. 2021;84:30–36.
  11. Tripathi DM, Vilaseca M, Lafoz E, Garcia-Caldero H, Haute GV, Fernandez-Iglesias A, et al. Simvastatin prevents progression of acute on chronic liver failure in rats with cirrhosis and portal hypertension. Gastroenterol. 2018;155(5):1564-77..
  12. Bishnu S, Ahammed SM, Sarkar A, Hembram J, Chatterjee S, Das K, et al. Effects of atorvastatin on portal hemodynamics and clinical outcomes in patients with cirrhosis with portal hypertension: a proof-of-concept study. Eu J Gastroenterol Hepatol. 2018;30(1):54-9..
  13. Shanti I, Samardali M, Abdeen AM, Joshi T, Ikram H, Frandah W, et al. S2819 A Meta-Analysis About the Efficacy of Statins on Hepatic Venous Pressure Gradient (HVPG) in Cirrhosis Disease. J Am Coll Gastroenterol. 2025;120(10S2):S605.
  14. Tarantino G, Citro V, Conca P. Doppler ultrasonographic assessment of portal hypertension: Non-invasive surrogate of HVPG? Ultrasound Med Biol. 2021;47(4):1097–106.
  15. Mandorfer M, Hernández-Gea V, García-Pagán JC, Reiberger T. Noninvasive diagnostics for portal hypertension: a comprehensive review. Thieme Medical Publishers. InSeminars Liver Disease. 2020;40(03);240-55).
  16. Elwan NM, Said MA, Shabana SS. Effect of simvastatin on portal hemodynamics in cirrhosis. Arab J Gastroenterol. 2020;21(2):74–78.
  17. Nader ND, Mosquera D, Burgos LG. Delayed clinical benefits of hemodynamic response to statins in cirrhosis: A longitudinal study. Liver Int. 2021;41(9):2073-82.
  18. Bai M, Qi XS, Yang ZP, Yang M, Fan DM, Han GH. Statins for portal hypertension: A meta-analysis of randomized controlled trials. Eur J Gastroenterol Hepatol. 2022;34(2):170–76.
  19. Simon TG, Duberg AS, Aleman S. Statin use and risk of cirrhosis and hepatocellular carcinoma in chronic hepatitis B or C: A nationwide study. Lancet Gastroenterol Hepatol. 2020;5(10):892–900.
  20. Kamal S, Khan MA, Seth A. Role of statins in reducing hepatocellular carcinoma risk in chronic liver disease: A meta-analysis. J Gastroenterol Hepatol. 2020;35(8):1330–38.
  21. Pose E, Trebicka J, Mookerjee RP. Statins: Old drugs as new therapy for liver diseases? J Hepatol. 2021;74(3):734-48.
  22. Di Pascoli M, Berzigotti A, Caraceni P. Statins in liver cirrhosis: Ready for prime time? JHEP Rep. 2021;3(6):1003-15.
  23. Watanabe A, Wakabayashi H, Uchiyama T. Accuracy of Doppler ultrasound in estimating portal hypertension severity. Clin Imaging. 2023;94:44-49.

Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. Authors retain copyright. © 2026 The Author(s).