Lipophilic statins tied to lower risk for hepatitis-related liver cancer

  • Simon TG & al.
  • Ann Intern Med
  • 20 Aug 2019

  • International Clinical Digest
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Takeaway

  • Lipophilic but not hydrophilic statins are tied to reduced risks for hepatocellular carcinoma (HCC) and liver-related death among patients with HCV and HBV.

Why this matters

  • Findings were consistent across subgroups, including sex, cirrhosis status, and antiviral therapy.

Study design

  • Propensity-matched cohort study; 16,668 adults with confirmed HBV (~23%) or HCV (~77%), Swedish national registries, including 8334 statin users (lipophilic, 78.6%; hydrophilic, 21.4%) vs 8334 nonusers.
  • Funding: Karolinska Institutet, NIH, others.

Key results

  • Median follow-up: 7.9 years, statin users; 8.0 years, nonusers.
  • 10-year adjusted HR (aHR) for incident HCC with lipophilic statins: 0.56 (95% CI, 0.41-0.79).
    • Absolute risk difference: −4.8% (3.3% vs 8.1%).
    • No association for hydrophilic statins: aHR, 0.95 (0.86-1.08).
  • 10-year HCC risk (aHRs; 95% CIs) with lipophilic statins: 
    • 0.54 (95% CI, 0.45-0.83), HCV;
    • 0.58 (95% CI, 0.48-0.78), HBV.
  • 10-year mortality (aHRs; 95% CIs) decreased with:
    • Lipophilic statins:
      • 7.3% vs 15.2%;
      • 0.62 (0.45-0.91).
    • Hydrophilic statins:
      • 11.5% vs 16.0%;
      • 0.88 (0.80-0.97).
  • Only lipophilic statins were associated with reduced risk for liver-related death:
    • aHR, 0.76 (95% CI, 0.50-0.92).
  • Lipophilic statins were linked to significant dose-dependent 10-year risk reduction for HCC (Ptrend<.001 and mortality>trend=.001).
    • Absolute HCC risk reduction by cumulative defined lipophilic statin daily dose (mg):
      • 30-299: −3.4%, −7.1%.
      • 300-599: −4.6%, −7.2%.
      • 600+: −5.9%, −9.6%.

Limitations

  • Viral load, fibrosis stage, use of direct-acting antivirals not captured.

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