Hepatology. 2019 Sep 25. doi: 10.1002/hep.30973. [Epub ahead of print]
Statin Use and the Risk of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B.
Goh MJ1, Sinn DH1, Kim S2, Woo SY2, Cho H2, Kang W1, Gwak GY1, Paik YH1, Choi MS1, Lee JH1, Koh KC1, Paik SW1.
Author information
1
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2
Statistics and Data Center, Samsung Medical Center, Seoul, Korea.
Abstract
Statins have pleiotropic effects which may include chemoprevention. Several observational studies have suggested that statins may prevent hepatocellular carcinoma (HCC) but they have not yet been fully studied in patients with chronic hepatitis B virus (HBV) infections. A hospital-based retrospective cohort of 7,713 chronic HBV-infected individuals between January 2008 and December 2012 were analyzed. The primary outcome was the development of HCC. Patients who used statins for at least 28 cumulative defined daily doses (cDDD) during the follow-up period were defined as statin users (n = 713). The association between the use of statin and the incidence of HCC was analyzed using the multivariable Cox regression model with time-dependent covariates. During a median follow-up of 7.2 years (min-max: 0.5-9.7), HCC newly developed in 702 patients (9.1%). Statin use was associated with a lower risk of HCC (adjusted hazard ratio (HR) = 0.36, 95% confidence interval (CI): 0.19-0.68, adjusted for age, sex, cirrhosis, diabetes, hypertension, serum alanine aminotransferase, cholesterol, HBV DNA level, antiviral treatment, and antiplatelet therapy). The observed benefit of the statin use was dose dependent (adjusted HR (95% CI), 0.63 (0.31-1.29); 0.51 (0.21-1.25); 0.32 (0.07,1.36); and 0.17 (0.06, 0.48) for patients with statin use of 28-365, 366-730, 731-1095, and more than 1095 cDDDs, respectively). In subgroup analysis, the association between statin use and reduced risk of HCC was observed in all pre-specified subgroups analyzed. CONCLUSIONS: Statin use was associated with a reduced risk of HCC development in chronic HBV-infected patients, suggesting that statin may have chemopreventive role in this population. These findings warrant a prospective evaluation.