Statins may cut risk of hepatocellular carcinoma
YOUR DOSE OF MEDICINE - Charles C. Chante MD (The Philippine Star) - August 3, 2014 - 12:00am

Statin therapy taken to prevent cardiovascular events also appears to protect against hepatocellular carcinoma, reducing the overall risk for the cancer by 37%, according to the results of a systematic review and meta-analysis.

In a meta-analysis of all the studies in the literature that have examined statins’ effect on HCC risk, use of the drugs was associated with a pronounced and consistent risk reduction (48%) in Asian populations, as well as a still-significant reduction (33%) in Western populations, reported at the Mayo Clinic, Rochester, Minn.

It does not seen prudent to prescribe statins for chemoprevention” of HCC in the general population, mainly because of the high number of people who would need to be treated to prevent a single case of HCC, the researchers noted. “In patients with multiple risk factors, such as East Asian men who have chronic HBV [hepatitis B Virus] infection, statins may have a clinically relevant chemo-protective effect against HCC.”

Prospective cohort studies or randomized clinical trials of the issue are warranted in populations at high risk for HCC.

The results of preclinical studies have suggested that statins may decrease the risk of cancers, perhaps because their antiproliferative, proapoptotic, antiangiogenic, immunomodulatory, and anti-infective effects may prevent cancer growth. But clinical studies have produced conflicting results. A systematic review of the literature for studies that clearly defined statin exposure, reported HCC risk, and either reported relative risks or odds ratios for the development of HCC or provided the data so those risks could be calculated. They then performed a meta-analysis of 10 studies: 7 observational studies and 3 that used pooled data from 26 randomized clinical trials.

Most of the studies were considered to be high quality and most accounted for a variety of potential confounders such as patient age; sex; medication use; and the presence of viral hepatitis, cirrhosis, diabetes, or alcoholic liver disease. The likelihood of selection bias and of publication bias in the included studies was judged to be very low.

Together, the 10 studies included 1,459,417 subjects and 4,298 cases of HCC.

In an initial analysis of the data, the use of statins was associated with a significant 41% reduction in the rate of HCC. After the data were adjusted to account for several potential confounders, the risk reduction was altered slightly, but a robust 37% reduction in HCC rate remained .

The researchers did an analysis of the data based on location of the studies, because the epidemiology of HCC is so different between Western and Asian populations. Statin use correlated with a 48% reduction in the rate of HCC in Asian populations, where viral hepatitis is the primary risk factor for the disease, and a 33% reduction in the rate of HCC in Western populations, where the metabolic syndrome, nonalcoholic fatty liver disease, and alcohol-related cirrhosis are the primary risk factors.

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