Today’s journal club focused on whether statins prevent hepatocellular carcinoma (HCC). It was a meta-analysis from a recent Gastroenterology publication (see link below). Statins (HMG-CoA reductase inhibitors) influence a long cascade of reactions that may affect neoangiogenesis (ie. Ras pathway), and are known to affect other important pathways of inflammation, immunomodulation etc.
A wide search was distilled down to ten articles, a heterogeneous group of works from Eastern and Western countries. These were largely articles on cardiovascular disease, and not all of them included comment on the cirrhotic population. There was evidence that the use of statins reduced the overall odds ratio of HCC, though dose and duration of use was not specified. Furthermore, the population studied appeared to make a difference; older, male, East Asian subjects were at highest risk and benefitted most, with a number-to-treat of only 57. Western cohorts had a far higher NNT and it was felt not to be of great benefit.
There is mounting evidence that statin use is very good for many reasons in the liver population. Reduction of portal hypertension, cholesterol levels (NASH) and now HCC are three areas of benefit. While the group concluded that they would not put a patient on a statin for the specific indication of HCC prophylaxis, this article does provide an additional reason why statins should not be withheld from somebody with advanced liver disease.