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Statin Use and the Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B
Author(s) -
Goh Myung Ji,
Sinn Dong Hyun,
Kim Seonwoo,
Woo Sook Young,
Cho Hyun,
Kang Wonseok,
Gwak GeumYoun,
Paik YongHan,
Choi Moon Seok,
Lee Joon Hyeok,
Koh Kwang Cheol,
Paik Seung Woon
Publication year - 2020
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.30973
Subject(s) - medicine , hazard ratio , hepatocellular carcinoma , statin , proportional hazards model , confidence interval , cumulative incidence , retrospective cohort study , gastroenterology , incidence (geometry) , cohort , physics , optics
Background and Aims Statins have pleiotropic effects that 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. Approach and Results 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 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: 0.5‐9.9), HCC newly developed in 702 patients (9.1%). Statin use was associated with a lower risk of HCC (adjusted hazard ratio = 0.36, 95% confidence interval: 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 hazard ratio [95% confidence interval], 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 1,095 cumulative defined daily doses, respectively). In subgroup analysis, the association between statin use and reduced risk of HCC was observed in all prespecified subgroups analyzed. Conclusion Statin use was associated with a reduced risk of HCC development in chronic HBV‐infected patients, suggesting that statins may have a chemopreventive role in this population. These findings warrant a prospective evaluation.