Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Republic of Korea.
J Hepatol. 2018 Mar;68(3):476-484. doi: 10.1016/j.jhep.2017.10.018. Epub 2017 Oct 26.
BACKGROUND & AIMS: Statins are widely used to treat hypercholesterolemia. Statins may prevent hepatocellular carcinoma (HCC), but have not yet been fully studied, particularly in patients at high risk. Therefore, we investigated the risk of HCC after statin use in the whole general population and evaluated the effects of preexisting diabetes mellitus (DM) and liver cirrhosis (LC) on that risk.
A nationwide, nested case-control study was conducted with data from the National Health Insurance Service Physical Health Examination Cohort 2002-2013 in the Republic of Korea. Individuals diagnosed with HCC were matched to controls based on the time of the follow-up, sex, and age at index date. Odds ratios (ORs) and 95% confidence intervals (CIs) for HCC associated with statin use were analyzed by multivariable conditional logistic regression analyses. In total, 1,642 HCC cases were matched to 8,210 control individuals from 514,866 participants.
Statin use was associated with reduced risk of HCC development (adjusted OR [AOR] 0.44; 95% CI 0.33-0.58) compared with nonusers. The reduction in risk was significant in the presence (AOR 0.28; 95% CI 0.17-0.46) and absence of DM (AOR 0.53; 95% CI 0.39-0.73) and in the presence (AOR 0.39; 95% CI 0.26-0.60) and absence of LC (AOR 0.42; 95% CI 0.32-0.57). Statin use also significantly reduced the risk of HCC among patients with DM, without chronic complications (AOR 0.19; 95% CI 0.08-0.46) or with chronic complications (AOR 0.34; 95% CI 0.19-0.64), compared to nonusers.
Statin use may have a beneficial inhibitory effect on HCC development, particularly in patients with DM or LC, at high risk of HCC.
In this longitudinal nationwide population-based nested case-control study, the association between statin use and the risk of HCC was investigated in Asian populations. Herein, we noted a beneficial effect of statin use on the development of HCC in the general population and individuals at high risk of HCC (i.e. those with diabetes or liver cirrhosis).
他汀类药物被广泛用于治疗高胆固醇血症。他汀类药物可能预防肝细胞癌（HCC），但尚未得到充分研究，尤其是在高危患者中。因此，我们研究了他汀类药物使用后在普通人群中发生 HCC 的风险，并评估了糖尿病（DM）和肝硬化（LC）的预先存在对该风险的影响。
在韩国，我们进行了一项全国性、嵌套病例对照研究，利用国家健康保险服务身体检查队列 2002-2013 年的数据。在随访时、性别和索引日期时，将 HCC 诊断病例与对照相匹配。使用多变量条件逻辑回归分析，分析了他汀类药物使用与 HCC 相关的比值比（OR）和 95%置信区间（CI）。在总共 514866 名参与者中，从 1642 例 HCC 病例中匹配了 8210 例对照。
与非使用者相比，他汀类药物使用者 HCC 发生风险降低（校正 OR [AOR]0.44；95%CI0.33-0.58）。在存在（AOR0.28；95%CI0.17-0.46）和不存在 DM（AOR0.53；95%CI0.39-0.73）以及存在（AOR0.39；95%CI0.26-0.60）和不存在 LC（AOR0.42；95%CI0.32-0.57）的情况下，风险降低更为显著。与非使用者相比，他汀类药物使用者在患有 DM（无慢性并发症，AOR0.19；95%CI0.08-0.46；有慢性并发症，AOR0.34；95%CI0.19-0.64）或无 DM（AOR0.42；95%CI0.32-0.57）的情况下，也显著降低了 HCC 发生风险。
他汀类药物的使用可能对 HCC 的发展有有益的抑制作用，特别是在 HCC 风险高的 DM 或 LC 患者中。
在这项亚洲人群的纵向全国性基于人群的嵌套病例对照研究中，我们研究了他汀类药物使用与 HCC 风险之间的关系。在此，我们注意到他汀类药物的使用对普通人群和 HCC 高危人群（即患有糖尿病或肝硬化的人群）的 HCC 发展有有益的影响。
