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Lipophilic Statins and Risk for Hepatocellular Carcinoma and Death in Patients With Chronic Viral Hepatitis: Results From a Nationwide Swedish Population
Massachusetts General Hospital and Harvard Medical School, Boston Massachusetts, USA.
Örebro University, School of Medical Sciences.ORCID iD: 0000-0001-7248-0910
Karolinska University Hospital, Stockholm, Sweden.
Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
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2019 (English)In: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 171, no 5, p. 318-327Article in journal (Refereed) Published
Abstract [en]

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

Objective: To assess the relationship between lipophilic or hydrophilic statin use and HCC incidence and mortality in a nationwide population with viral hepatitis.

Design: Prospective propensity score (PS)-matched cohort.

Setting: Swedish registers, 2005 to 2013.

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

Measurements: Time to incident HCC, ascertained from validated registers. Statin use was defined from filled prescriptions as 30 or more cumulative defined daily doses (cDDDs).

Results: Compared with matched nonusers, 10-year HCC 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 in- verse association between lipophilic statins and HCC risk seemed to be dose-dependent. Compared with nonusers, 10-year HCC 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 -62 percentage points]) and hydrophilic (16.0% vs. 11.5%; RD, -4.5 percentage points [CI, -6.0 to -3.0 percentage points]) statin users.

Limitation: Lack of lipid, fibrosis, or HCC surveillance data.

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

Place, publisher, year, edition, pages
American College of Physicians , 2019. Vol. 171, no 5, p. 318-327
National Category
General Practice
Identifiers
URN: urn:nbn:se:oru:diva-76548DOI: 10.7326/M18-2753ISI: 000484610900004PubMedID: 31426090Scopus ID: 2-s2.0-85072077551OAI: oai:DiVA.org:oru-76548DiVA, id: diva2:1352935
Funder
Stockholm County Council
Note

Funding Agencies:

North American Training Grant from the American College of Gastroenterology  

Research ALF grant from Region Örebro County  OLL-683801 

National Institutes of Health  K23 DK099681  K24 DK078772

Available from: 2019-09-20 Created: 2019-09-20 Last updated: 2019-09-20Bibliographically approved

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