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Patients with chronic viral hepatitis: lipophilic statins were associated with significantly reduced hepatocellular carcinoma incidence and mortality


Whether statin type influences hepatocellular carcinoma ( HCC ) incidence or mortality in chronic hepatitis B or C virus infection is unknown.

The objective of study was to assess the relationship between lipophilic or hydrophilic statin use and hepatocellular carcinoma incidence and mortality in a nationwide population with viral hepatitis.

Researchers used Swedish registers, 2005 to 2013.

A propensity score-matched cohort of 16 668 adults ( 8334 who initiated statin use [ 6554 lipophilic and 1780 hydrophilic ] and 8334 nonusers ) among 63 279 eligible adults.

The main measurement was time to incident hepatocellular carcinoma, ascertained from validated registers.
Statin use was defined from filled prescriptions as 30 or more cumulative defined daily doses ( cDDDs ).

Compared with matched nonusers, 10-year hepatocellular carcinoma risk was significantly 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 hepatocellular carcinoma risk seemed to be dose-dependent.

Compared with nonusers, 10-year hepatocellular carcinoma 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 among 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.

In a nationwide viral hepatitis cohort, lipophilic statins were associated with significantly reduced hepatocellular carcinoma incidence and mortality.
An association between hydrophilic statins and reduced risk for hepatocellular carcinoma was not found.
Further research is needed to determine whether lipophilic statin therapy is feasible for prevention of hepatocellular carcinoma. ( Xagena )

Simon TG et al, Ann Intern Med 2019; DOI: 10.7326/M18-2753

XagenaMedicine_2019



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