title: Statin and the risk of hepatocellular carcinoma and death in a hospital-based hepatitis B-infected population: A propensity score landmark analysis.
abstract: OBJECTIVE
  The use of statin in hepatocellular carcinoma (HCC) and death prevention is still uncertain among hepatitis B infected (HBV) patients. This study aimed to examine the effect of statin on HCC and death in a HBV population.
  
  
  METHODS
  We conducted a hospital-based population study of HBV patients, using the Hospital Authority database in Hong Kong. We defined statin use by landmark analysis to abrogate "immortal time bias" and propensity score (PS) weighting to minimize baseline confounders and "indication bias". Multiple imputations for missing data were performed. The weighted Cox regression analyses was performed for the risk of HCC (adjusting for competing mortality) and death.
  
  
  RESULTS
  A total of 73,499 patients with a crude HCC incidence of 1.75 per 100 patient-years were entered into the 2-year landmark analysis. After landmark analysis and PS weighting of baseline covariates, statin users had a 32% risk reduction in HCC (weighted sub-hazard ratio (SHR) 0.68; 95% CI 0.48-0.97) compared to non-users. There was no decreased risk of death in statin users (weighted HR 0.92; 0.76-1.11, p=0.386). In subgroup analysis, concurrent statin and nucleos(t)ide analogue (NA) use was associated with 59% risk reduction in HCC (weighted SHR 0.41; 0.19-0.89, p=0.023) compared to NA use alone.
  
  
  CONCLUSIONS
  In this HBV cohort adjusted for confounders and biases, statin use is associated with reduced HCC risk by 32%. Additive HCC chemopreventive effect was seen with the concomitant use of NA and statin. Further prospective studies are warranted to investigate the potential use of statin in NA users.
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: John Chen
authors.initials: JC
authors.lastname: Hsiang
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Grace Lai-Hung
authors.initials: GL
authors.lastname: Wong
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Yee-Kit
authors.initials: YK
authors.lastname: Tse
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Vincent Wai-Sun
authors.initials: VW
authors.lastname: Wong
authors.affiliation: Department of Statistics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Terry Cheuk-Fung
authors.initials: TC
authors.lastname: Yip
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: hlychan@cuhk.edu.hk.
authors.forename: Henry Lik-Yuen
authors.initials: HL
authors.lastname: Chan
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D002423:Cause of Death / Q000639:trends; D003428:Cross Infection; D005260:Female; D005500:Follow-Up Studies; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D007297:Inpatients; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D057216:Propensity Score; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Alanine aminotransferase; Albumin; Death; Hepatitis B; Hepatocellular carcinoma; Landmark analysis; Nucleos(t)ide analogue; Statin