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

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 (P_trend<.001) and mortality (P_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.