Statin Use Linked to Reduced Risk of HCC and Liver Decompensation in Chronic Liver Disease

In a large cohort study published in JAMA Internal Medicine, involving over 16,000 adults with chronic liver disease (CLD), statin use was significantly associated with a reduced risk of hepatocellular carcinoma (HCC), hepatic decompensation, and progression of liver fibrosis, as measured by Fibrosis-4 (FIB-4) scores.

The study analyzed data from the Research Patient Data Registry between 2000 and 2023, focusing on patients aged 40 and older with a baseline FIB-4 score of 1.3 or higher. Participants were grouped based on statin exposure, defined as a cumulative defined daily dose (cDDD) of 30 or more.

Statin users experienced markedly better clinical outcomes over a 10-year period. The cumulative incidence of HCC was 3.8% among statin users compared with 8.0% in nonusers (risk difference, −4.2%; 95% CI, −5.3 to −3.1). Similarly, hepatic decompensation occurred in 10.6% of statin users versus 19.5% of nonusers (risk difference, −9.0%; 95% CI, −10.6 to −7.3).

“These findings demonstrate a clear association between statin use and reduced risk of both hepatocellular carcinoma and liver decompensation in patients with chronic liver disease,” the authors wrote.

The adjusted subhazard ratio (aSHR) for HCC was 0.67 (95% CI, 0.59 to 0.76), and for hepatic decompensation, 0.78 (95% CI, 0.67 to 0.91). Longer duration of use (≥600 cDDDs) and lipophilic statins were linked to further reductions in risk.

Among the 7,038 patients with serial FIB-4 measurements, statin users showed more favorable transitions in fibrosis risk category. For those with high baseline FIB-4 scores, 31.8% of statin users moved to the intermediate group and 7.0% to the low-risk group, compared to 18.8% and 4.3% of nonusers, respectively (P < .001).

The study concluded, “Statin use was associated with a reduced risk of HCC and hepatic decompensation in patients with CLD, as well as improved FIB-4 group transitions over time.”

These results support the potential role of statins not only in cardiovascular disease management but also in modifying liver disease progression and reducing cancer risk in CLD populations.

Reference
Choi J, Nguyen VH, Przybyszewski E, et al. Statin use and risk of hepatocellular carcinoma and liver fibrosis in chronic liver disease. JAMA Intern Med. Published online March 17, 2025. doi:10.1001/jamainternmed.2025.0115