title: Statins are associated with a reduced risk of hepatocellular carcinoma in a large cohort of patients with diabetes.
abstract: OBJECTIVE
  Experimental studies indicate a potential cancer prevention effect for statins. Given the increasing prevalence of statin use, and the increasing incidence of hepatocellular carcinoma (HCC), the potential association between statins and HCC is an important issue to examine.
  
  
  METHODS
  We conducted a matched case-control study nested within a cohort of patients with diabetes. Cases comprised incident HCC at least 6 months after entry in the cohort. Controls were identified by incidence density sampling from patients who remained at risk at the date of the HCC diagnosis matched by age and sex. We identified filled statin prescriptions as well as several potential confounding conditions, medications, as well as propensity score to use statins. Odds ratios (ORs) as estimates of the relative risk for HCC associated with statin use and 95% confidence intervals were obtained using conditional logistic regression.
  
  
  RESULTS
  We examined 1303 cases and 5212 controls. The mean age was 72 years and 99% were men. A significantly smaller proportion of cases (34.3%) had at least one filled prescription for statins than controls (53.1%). There were no significant associations between HCC and nonstatin cholesterol- or triglyceride-lowering medications. The unadjusted OR for any statin prescription was 0.46 (95% confidence interval, 0.40-0.517) and the adjusted OR was 0.74 (95% confidence interval, 0.64-0.87). To reduce the potential confounding effect of existing liver disease, we ran the analyses in a subgroup of patients without recorded liver disease; the ORs were slightly attenuated but remained highly significant for any statin prescription (0.63; 95% confidence interval, 0.50-0.78).
  
  
  CONCLUSIONS
  Statin use is associated with a significant reduction in the risk of HCC among patients with diabetes.
authors.affiliation: Section of Gastroenterology at the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA. hasheme@bcm.tmc.edu
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
authors.forename: Michael L
authors.initials: ML
authors.lastname: Johnson
authors.forename: Christine
authors.initials: C
authors.lastname: Hachem
authors.forename: Robert O
authors.initials: RO
authors.lastname: Morgana
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000517:prevention & control*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008107:Liver Diseases / Q000150:complications; D008113:Liver Neoplasms / Q000517:prevention & control*; D008297:Male; D012306:Risk
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors