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Statins May Reduce Liver Cancer Risk among People with Hepatitis B

Statins, a class of drugs used to manage elevated blood cholesterol, may also play a role in fighting hepatocellular carcinoma (HCC) -- a form of primary liver cancer -- among people with chronic hepatitis B, according to a report in the January 23, 2012, advance online edition of the Journal of Clinical Oncology.

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Over years or decades, chronic hepatitis B virus (HBV) infection can progress to advanced liver disease including fibrosis, cirrhosis (scarring), and liver cancer. HCC is common in countries where HBV is endemic and often contracted at birth, including several countries in Asia.

Yu-Tse Tsanand Pau-Chung Chen from National Taiwan University and colleagues investigated the association between use of statins -- also known as HMG-CoA reductase inhibitors -- and risk of HCC in chronic hepatitis B patients, noting that these drugs have demonstrated a potential protective effect against certain other types of cancer.

The researchers conducted a population-based cohort study using information from 33,413 people with HBV identified in the Taiwan National Health Insurance Research Database. Each patient was tracked from 1997 through 2008 to identify incident (new) cases of HCC since 1999.

The authors noted whether participants used statins, other lipid-lowering agents, aspirin, and/or angiotensin-converting enzyme (ACE) inhibitors, and looked for an association between statin use and occurrence of HCC. Participants were not randomly assigned to receive statins versus placebo, meaning other confounding factors could have played a role.

Results

  • A total of 1021 new HCC cases occurred in the hepatitis B cohort during the follow-up period (328,946 total person-years).
  • The overall incidence rate was 310.4 HCC cases per 100,000 person-years.
  • There was a "dose-response" relationship between statin use and HCC in the hepatitis B cohort, with the risk going down as drug duration increased:

o      Statin use of 28 to 90 cumulative defined daily doses: adjusted hazard ratio (HR) 0.66, or one-third less risk compared with no statin use;

o      91 to 365 cumulative daily doses: HR 0.41;

o      More than 365 cumulative daily doses: HR 0.34.

Based on these findings, the researchers concluded, "Statin use may reduce the risk for HCC in HBV-infected patients in a dose-dependent manner," adding that "[f]urther mechanistic research is needed" to verify and explain this effect.

A caveat to this research is that statins have the potential to cause liver toxicity and are often not recommended for people with existing liver disease. But studies indicate that many patients with chronic hepatitis B can safely take statins -- especially some newer drugs in this class -- if they receive regular liver function monitoring.

Investigator affiliations: National Taiwan University College of Public Health, Taipei; National Taiwan University College of Medicine and Hospital, Taipei; Taichung Veterans General Hospital, Taichung; Chung Shan Medical University, Taichung, Taiwan; Ton Yen General Hospital, Hisn-Chu County; National Cheng Kung University College of Medicine, Tainan, Taiwan.

2/10/12

Reference

YT Tsan, CH Lee, JD Wang, PC Chen, et al. Statinsand the Risk of Hepatocellular Carcinoma in Patients With Hepatitis B Virus Infection. Journal of Clinical Oncology. January 23, 2012 (Epub ahead of print).