Lipophilic Statins and Risk for Hepatocellular Carcinoma and Death in Patients With Chronic Viral Hepatitis: Results From a Nationwide Swedish Population
Tracey G. Simon, MD, MPH; Ann-Sofi Duberg, MD, PhD; Soo Aleman, MD, PhD; Hannes Hagstrom, MD, PhD; Long H. Nguyen, MD, MPH; Hamed Khalili, MD, MPH; Raymond T Chung, MD; Jonas F. Ludvigsson, MD, PhD
Abstract
Background:
Whether statin type influences hepatocellular carcinoma (HCC) incidence or mortality in chronic hepatitis B or C virus infection is unknown.
Objective:
To assess the relationship between lipophilic or hydrophilic statin use and HCC incidence and mortality in a nationwide population with viral hepatitis.
Design:
A PS-matched cohort of 16 668 adults (8334 who initiated statin use [6554 lipophilic and 1780 hydrophilic] and 8334 nonusers) among 63 279 eligible adults.
Measurements:
Time to incident HCC, ascertained from validated registers. Statin use was defined from filled prescriptions as 30 or more cumulative defined daily doses (cDDDs).
Results:
Compared with matched nonusers, 10-year HCC risk was significant lower among lipophilic statin users (8.1% vs. 3.3%; absolute risk difference [RD], −4.8 percentage points [95% CI, −6.2 to −3.3 percentage points]; Adjusted subdistribution hazard ratio [aHR], 0.56 [CI, 0.41 to 0.79]) but not hydrophilic statin users (8.0% vs. 6.8%; RD, −1.2 percentage points [CI, −2.6 to 0.4 percentage points]; aHR, 0.95 [CI, 0.86 to 1.08). The inverse association between lipophilic statins and HCC risk seems to be dose-dependent. Compared with nonusers, 10-year HCC risk was lowest with 600 or more lipophilic statin cDDDs (8.4% vs. 2.5%; RD, −5.9 percentage points [CI, −7.6 to −4.2 percentage points]; aHR, 0.41 [CI, 0.32 to 0.61]), and 10-year mortality was significantly lower in both lipophilic (15.2% vs. 7.3%; RD , −7.9 percentage points [CI, −9.6 to −6.2 percentage points]) and hydrophilic (16.0% vs. 11.5%; RD, −4.5 percentage points [CI, −6.0 to −3.0 percentage points ]) statin users.
Limitation:
Lack of lipid, fibrosis, or HCC surveillance data.
Conclusion:
In a nationwide viral hepatitis cohort, lipophilic statins were associated with significant reduced HCC incidence and mortality. An association between hydrophilic statins and reduced risk for HCC was not found. Further research is needed to determine whether lipophilic statin therapy is feasible for prevention of HCC.
Primary Funding Source:
None.作者: StephenW 时间: 2019-8-20 12:41
亲脂性他汀类药物与慢性病毒性肝炎患者肝细胞癌和死亡的风险：来自全国瑞典人群的结果
Tracey G. Simon，医学博士，公共卫生硕士; Ann-Sofi Duberg，医学博士，博士; Soo Aleman，医学博士，博士; Hannes Hagstrom，医学博士，博士; Long H. Nguyen，MD，MPH; Hamed Khalili，医学博士，公共卫生硕士; Raymond T Chung，MD; Jonas F. Ludvigsson，医学博士，博士
Lipophilic statins associated with significantly reduced liver cancer incidence and mortality
Embargoed news from Annals of Internal Medicine
American College of Physicians
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information.
1. Lipophilic statins associated with significantly reduced liver cancer incidence and mortality
Lipophilic statins were associated with significantly reduced hepatocellular carcinoma (HCC) incidence and mortality, but an association between hydrophilic statins and reduced risk for HCC was not found. Further research is needed to determine whether lipophilic statin therapy is feasible for prevention of HCC. Findings from a nationwide cohort study are published in Annals of Internal Medicine.
Approximately 500,000 cases of HCC are diagnosed worldwide each year, related primarily to chronic infection with hepatitis B virus or hepatitis C virus. In the U.S. and Europe, incidence of HCC has tripled since the 1970s and mortality is increasing more rapidly for HCC than for any other cancer. As such, there is an urgent need to identify effective primary prevention strategies. Whether statin type influences hepatocellular carcinoma (HCC) incidence or mortality is unknown.
Researchers from the Karolinska Institutet, Stockholm, Sweden and Harvard University, Boston, US, studied a nationwide Swedish registry of adults with viral hepatitis B or C to assess the relationship between lipophilic or hydrophilic statin use and HCC incidence and mortality. Compared with a matched cohort that did not use statins, lipophilic statin use was associated with substantially lower risk for incident HCC, all-cause death, and liver-related death. The apparent benefits of lipophilic statins were dose and duration-dependent, with the greatest reduction in HCC risk occurring after at least 600 cumulative defined daily doses (the equivalent of taking a moderate-dose statin for approximately 2 years). A similar association with reduced HCC risk was not found with hydrophilic statin use. According to the researchers, these findings confirm prior data linking statins with improved survival and reduced HCC risk in chronic liver disease.
Notes and media contacts: For an embargoed PDF please contact Lauren Evans at [email protected]. To speak with author Jonas F. Ludvigsson, MD, PhD, please contact Andreas Andersson at [email protected] or [email protected]. 作者: StephenW 时间: 2019-8-20 12:44