Statin use and risk of primary liver cancer in the Clinical Practice Research Datalink.
BACKGROUND
Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are widely prescribed to reduce cholesterol levels. Studies have suggested that statins are associated with reduced risk of liver cancer, but much of the evidence is from regions of the world with high liver cancer incidence rates. The current study examined the statins-liver cancer relationship in a low-rate region and examined the effects of preexisting liver disease and diabetes on that association.


METHODS
A nested case-control study was conducted within the United Kingdom's Clinical Practice Research Datalink (CPRD). Persons diagnosed with primary liver cancer between 1988 and 2011 were matched to controls at a four-to-one ratio. Matches stratified on liver disease and on diabetes were also completed. Odds ratios (ORs) and 95% confidence intervals (CIs) for associations of statins with liver cancer were estimated using conditional logistic regression.


RESULTS
In total, 1195 persons with primary liver cancer were matched to 4640 control patients. Statin use was associated with a statistically significantly reduced risk of liver cancer (ORadj = 0.55, 95% CI = 0.45 to 0.69), especially among current users (ORadj = 0.53, 95% CI = 0.42 to 0.66). The reduced risk was statistically significant in the presence (ORadj = 0.32, 95% CI = 0.17 to 0.57) and absence of liver disease (ORadj = 0.65, 95% CI = 0.52 to 0.81) and in the presence (ORadj = 0.30, 95% CI = 0.21 to 0.42) and absence of diabetes (ORadj = 0.66, 95% CI = 0.51 to 0.85).


CONCLUSIONS
In the current study in a low-rate area, statin use was associated with a statistically significantly reduced risk of liver cancer overall. Risk was particularly reduced among persons with liver disease and persons with diabetes, suggesting that statin use may be especially beneficial in persons at elevated risk of liver cancer.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (KAM, JC, BIG, VVS); Boston Collaborative Drug Surveillance Program and Boston University School of Public Health, Lexington, MA (KH, SJ); Fox Chase Cancer Center, Philadelphia, PA (WTL); Hepatitis B Foundation, Doylestown, PA (WTL); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (VVS). mcglynnk@mail.nih.gov.
Katherine A
KA
McGlynn
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (KAM, JC, BIG, VVS); Boston Collaborative Drug Surveillance Program and Boston University School of Public Health, Lexington, MA (KH, SJ); Fox Chase Cancer Center, Philadelphia, PA (WTL); Hepatitis B Foundation, Doylestown, PA (WTL); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (VVS).
Katrina
K
Hagberg
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (KAM, JC, BIG, VVS); Boston Collaborative Drug Surveillance Program and Boston University School of Public Health, Lexington, MA (KH, SJ); Fox Chase Cancer Center, Philadelphia, PA (WTL); Hepatitis B Foundation, Doylestown, PA (WTL); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (VVS).
Jie
J
Chen
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (KAM, JC, BIG, VVS); Boston Collaborative Drug Surveillance Program and Boston University School of Public Health, Lexington, MA (KH, SJ); Fox Chase Cancer Center, Philadelphia, PA (WTL); Hepatitis B Foundation, Doylestown, PA (WTL); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (VVS).
Barry I
BI
Graubard
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (KAM, JC, BIG, VVS); Boston Collaborative Drug Surveillance Program and Boston University School of Public Health, Lexington, MA (KH, SJ); Fox Chase Cancer Center, Philadelphia, PA (WTL); Hepatitis B Foundation, Doylestown, PA (WTL); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (VVS).
W Thomas
WT
London
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (KAM, JC, BIG, VVS); Boston Collaborative Drug Surveillance Program and Boston University School of Public Health, Lexington, MA (KH, SJ); Fox Chase Cancer Center, Philadelphia, PA (WTL); Hepatitis B Foundation, Doylestown, PA (WTL); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (VVS).
Susan
S
Jick
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (KAM, JC, BIG, VVS); Boston Collaborative Drug Surveillance Program and Boston University School of Public Health, Lexington, MA (KH, SJ); Fox Chase Cancer Center, Philadelphia, PA (WTL); Hepatitis B Foundation, Doylestown, PA (WTL); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (VVS).
Vikrant V
VV
Sahasrabuddhe
D000368:Aged; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008107:Liver Diseases / Q000150:complications; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018570:Risk Assessment; D006113:United Kingdom / Q000453:epidemiology
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors