Lipophilic statins were linked to a lower risk of hepatocellular carcinoma and death among a nationwide cohort of Swedish patients with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV). The prospective cohort findings were published online August 20, 2019, in the Annals of Internal Medicine.

Adult patients with HBV or HCV in Sweden were identified using the Register for Surveillance of Communicable Diseases, which was linked to Patient Register, the Cause of Death Register, the Cancer Register, and the Prescribed Drug Register at the National Board of Health and Welfare. The study cohort included patients who filled their first prescription for lipophilic or hydrophilic statins between July 1, 2005, and December 31, 2013.

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Using a propensity score-matched, prospective cohort design, the study authors identified 16,668 patients, of whom 3906 had HBV and 12,762 had HCV. The entire cohort included 6554 patients who were prescribed lipophilic statins and 1780 patients who were prescribed hydrophilic statins; these patients were equally matched to 8334 patients who were not prescribed statins.

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At a median follow-up of approximately 8 years, 616 cases of hepatocellular carcinoma were detected and 1803 patients had died.

Patients who were prescribed lipophilic statins had a lower 10-year cumulative incidence of HCC compared with patients who were not prescribed statins (3.3% vs 8.1%; adjusted hazard ratio [aHR], 0.56; 95% CI, 0.41-0.79), but a lower risk of HCC was not seen among patients prescribed hydrophilic statins (6.8% vs 8.0%; aHR, 0.95; 95% CI, 0.86-1.08).

Patients prescribed lipophilic statins had a lower 10-year mortality rate compared with patients who were not prescribed statins, as well (7.3% vs 15.2%; aHR, 0.62; 95% CI, 0.45-0.91). Patients prescribed hydrophilic statins also had a lower 10-year mortality (11.5% vs 16.0%; aHR=0.88; 95% CI, 0.80-0.97), albeit had a smaller effect than seen with lipophilic statins.

“These findings support further research to characterize the potential hepatoprotective benefits of lipophilic statins,” the study authors wrote.


Simon TG, Duberg AS, Aleman S, et al. Lipophilic statins and risk for hepatocellular carcinoma and death in patients with chronic viral hepatitis: results from a nationwide Swedish population. Ann Intern Med. doi: 10.7326/M18-2753