STATINS are drugs commonly used to lower levels of low-density lipoprotein (LDL) cholesterol globally. A recent study has investigated the relationship between statin use in patients with chronic liver disease (CLD), and risk of hepatocellular carcinoma (HCC), and liver fibrosis progression. Researchers found that statin use decreased risk of HCC development, hepatic decompensation, and liver fibrosis progression, with further benefits observed with lipophilic statins or longer term use.
The cohort study analysed data from the Research Patient Data Registry from 2000–2023, including 16,501 patients, 40 years or older, with CLD and a baseline Fibrosis-4 (FIB-4) score of 1.3 or higher. The participants were split into statin users (n=3610) and non-users (n=12,891). Analysis of seven statins was included, and data regarding use was collected, defined by cumulative defined daily dose (cDDD).
Findings indicated that statin use was associated with a 33% reduction in the 10-year cumulative incidence of HCC and a 22% reduction in the risk of hepatic decompensation compared to non-users. Specifically, statin users had a 3.8% incidence of HCC, compared to 8% in non-users (risk difference: −4.2%; 95% CI: –5.3%––3.1%), and a 10.6% incidence of hepatic decompensation, compared to 19.5% in non-users (risk difference: –9.0%; 95% CI: –10.6%––7.3%). The findings also showed that the effects were heightened in patients with longer term statin use (≥600 cDDD) and users of lipophilic statins, such as atorvastatin, simvastatin, and lovastatin.
The analysis also revealed a significant reduction in liver fibrosis progression among statin users, as demonstrated by more favourable transitions in Fibrosis-4 (FIB-4) risk categories over time. 14.7% (95% CI: 13.0%–16.5%) of statin users with intermediate baseline FIB-4 scores transitioned to the high-risk group, compared with 20% (95% CI: 18.6%–21.5%) of non-users. Furthermore, in patients with high baseline FIB-4 scores, 31.8% (95% CI: 28.0%–35.9%) of statin users transitioned to the intermediate group, and 7% (95% CI: 5.2%–9.6%) transitioned to the low-risk group, compared to 18.8% (95% CI: 17.2%–20.6%) and 4.3% (95% CI: 3.5%–5.2%) of non-users, respectively.
This study highlights the potential role of statins in reducing the risk of liver cancer and decompensation in CLD patients, as well as slowing liver fibrosis progression. However, authors noted that the non-randomised nature of the study and possible confounders limit the ability to draw causal conclusions. Further research aims to conduct randomised clinical trials, with greater sample sizes and long-term follow up to validate the findings of this study.
Reference
Choi J et al. Statin Use and Risk of Hepatocellular Carcinoma and Liver Fibrosis in Chronic Liver Disease. JAMA Intern Med. 2025; DOI: 10.1001/jamainternmed.2025.0115.
