Statins and Risk Reduction in Hepatocellular Carcinoma: Fact or Fiction?

Abstract

and the Risk of Hepatocellular Carcinoma in Patients With Hepatitis B Virus Infection.” In this population-based cohort study that used the Taiwan National Health Insurance Research Database, the authors reported that statin use may reduce the risk of hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV) infection. Tsan et al 1 followed 33,413 patients with HBV infection from 1997 to 2008, of which 8.3% used statins and noted 1,021 incident HCC cases in this HBV cohort. The incidence rate (per 100,000 person-years) of HCC in patients on statins was 210.9, compared with an incidence rate of 319.5 in nonusers (P .001). The crude and adjusted hazard ratios (95% CIs) for HCC in statin users compared with nonusers was 0.66 (0.51 to 0.86) and 0.47 (0.36 to 0.61), respectively. The authors appropriately adjusted for potential confounders (age, sex, cirrhosis, diabetes, and medications such as anti-HBV treatment, aspirin, and angiotensin converting enzyme inhibitors) and acknowledged unmeasured confounders (alcohol intake, smoking status, and body mass index) as a limitation of their study. However, in their analysis, Tsan et al 1 failed to account for the impact of antidiabetic medications on altering the risk of HCC. It is now well established that diabetes is an independent risk factor for HCC as reported in several observational studies from Asia, Europe, and North America and subsequent metaanalyses. 2-4 Interestingly, recent studies have reported that antidiabetic medications also alter the risk of multiple cancers, including HCC. Population- and hospital-based observational studies in patients with diabetes have shown that metformin and thiazolidinediones are associated with reduced risk of HCC. 5-7 In a