title: Statins and primary liver cancer: a meta-analysis of observational studies.
abstract: Statins are among the most commonly prescribed drugs used to manage dyslipidemia. Hepatocellular carcinoma is the third leading cause of cancer mortality and its rates have recently been increasing in central and northern Europe and USA. To quantify the association between statin use and risk for HCC, we performed a meta-analysis of published studies. We conducted a MEDLINE search for observational studies reporting the association between exposure to statins and risk for incident liver cancer until March 2012. Fixed-effect and random-effect models were used to estimate summary relative risks (RR) and the corresponding 95% confidence intervals (CIs). Moreover, between-study heterogeneity and publication bias were assessed using adequate statistical tests. Five observational studies (two case-control and three cohort studies) based on 2574 cases of HCC were included. Statin treatment, compared with no treatment, was inversely related to HCC (summary RR=0.58; 95% CI 0.46-0.74). Between-study heterogeneity was significant (P<0.001) and numerically relevant (I=65%). When only longest statin use was considered, the RR was 0.66 (95% CI 0.55-0.80). Influence analysis on the overall estimate showed that heterogeneity was largely because of one study; when omitting it, the I dropped to 27% (P=0.240), whereas the summary RR was only marginally modified (RR=0.52; 95% CI 0.44-0.62). There was no evidence of publication bias. This meta-analysis suggests a favorable effect of statins on HCC, in the absence, however, of a duration-risk relationship.
authors.affiliation: Department of Statistics, Units of Biostatistics and Epidemiology, University of Milano-Bicocca, Milan, Italy.
authors.forename: Danitza
authors.initials: D
authors.lastname: Pradelli
authors.forename: Davide
authors.initials: D
authors.lastname: Soranna
authors.forename: Lorenza
authors.initials: L
authors.lastname: Scotti
authors.forename: Antonella
authors.initials: A
authors.lastname: Zambon
authors.forename: Alberico
authors.initials: A
authors.lastname: Catapano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corrao
mesh_terms: D016022:Case-Control Studies; D015331:Cohort Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors