Cho Hyo Jung, Lee Eunyoung, Kim Soon Sun, Cheong Jae Youn
Department of Gastroenterology, Ajou University School of Medicine, Worldcup-Ro 164, Yeongtong-Gu, Suwon, 16499, South Korea.
Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, USA.
Dig Dis Sci. 2025 Mar 19. doi: 10.1007/s10620-025-08935-x.
BACKGROUND/AIM: This study aimed to evaluate the effects of antihypertensives, lipid-lowering agents, and antiplatelet medications on hepatocellular carcinoma (HCC) risk in patients with fatty liver disease (FLD) and type 2 diabetes (T2D).
Using data from Korea Health Insurance Review and Assessment Service, 212,443 FLD-T2D patients were analyzed through Cox regression, propensity score matching (PSM), and Kaplan-Meier analysis. The analysis considered medication use and its relation to HCC development. Cohort admission day was set as the date of the first oral hypoglycemic prescription.
The multivariate Cox regression analysis revealed that old age, male sex, chronic viral hepatitis, alcoholic liver disease, liver cirrhosis, using a combination of insulin and oral hypoglycemic agents for antidiabetic treatment, and calcium channel blocker (CCB) use were significantly correlated with higher HCC development risk, whereas dyslipidemia and statin, ezetimibe, and fibrate use was correlated with lower HCC risk, in the study cohort of 212,443 patients. Patients who used statins (hazard ratio [HR] = 0.58, 95% confidence interval [CI] = 0.42-0.80, P = 0.001) and fibrates (HR = 0.46, 95% CI = 0.22-0.93, P = 0.031) showed a significantly lower risk of HCC development even after PSM. In contrast, CCB use was linked to an elevated HCC risk (HR = 1.35, 95% CI = 1.05-1.72, P = 0.019), highlighting the differential impact of various medications on HCC incidence.
The use of specific medications, such as statins and fibrates, may offer protective effects against HCC in patients with FLD-T2D, whereas that of CCB may increase the risk. This underscores the importance of tailored medication strategies for the management of chronic conditions.
背景/目的：本研究旨在评估抗高血压药、降脂药和抗血小板药物对脂肪肝疾病（FLD）和2型糖尿病（T2D）患者肝细胞癌（HCC）风险的影响。
利用韩国健康保险审查和评估服务的数据，通过Cox回归、倾向评分匹配（PSM）和Kaplan-Meier分析对212,443例FLD-T2D患者进行分析。该分析考虑了药物使用及其与HCC发生的关系。队列入院日期设定为首次口服降糖药处方的日期。
在212,443例患者的研究队列中，多变量Cox回归分析显示，老年、男性、慢性病毒性肝炎、酒精性肝病、肝硬化、联合使用胰岛素和口服降糖药进行抗糖尿病治疗以及使用钙通道阻滞剂（CCB）与较高的HCC发生风险显著相关，而血脂异常以及使用他汀类药物、依折麦布和贝特类药物与较低的HCC风险相关。使用他汀类药物（风险比[HR]=0.58，95%置信区间[CI]=0.42-0.80，P=0.001）和贝特类药物（HR=0.46，95%CI=0.22-0.93，P=0.031）的患者即使在PSM后HCC发生风险也显著降低。相比之下，使用CCB与HCC风险升高相关（HR=1.35，95%CI=1.05-1.72，P=0.019），突出了各种药物对HCC发病率的不同影响。
使用特定药物，如他汀类药物和贝特类药物，可能对FLD-T2D患者的HCC具有保护作用，而CCB的使用可能会增加风险。这强调了针对慢性病管理制定个性化药物治疗策略的重要性。
