Yonsei Med J.  2019 Dec;60(12):1203-1208. 10.3349/ymj.2019.60.12.1203.

Effect of Statin Use on Liver Cancer Mortality Considering Hypercholesterolemia and Obesity in Patients with Non-Cirrhotic Chronic Hepatitis B

  • 1Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Korea. joyshim@khu.ac.kr
  • 2Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 3Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 4Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
  • 5Department of Medical Education and Humanities, School of Medicine, Kyung Hee University, Seoul, Korea.


Little is known about the benefits of statin use on liver cancer mortality among patients with chronic hepatitis B (CHB) considering hypercholesterolemia and obesity. A nationwide retrospective cohort study was conducted using data from a Health Examination Cohort of the National Health Insurance Service of Korea. Data on CHB patients with no other concurrent liver disease were acquired, and statin use was defined as a cumulative daily dose ≥28. A 3-year landmark analysis was performed to avoid immortal time bias. Patients who started statin therapy within the landmark date were considered statin users. A Cox regression analysis was applied to assess associations between statin use and liver cancer mortality considering hypercholesterolemia and obesity. Among 13063 patients, 193 (1.5%) died of liver cancer during the mean follow-up period of 10.6 years. After adjusting for demographic and metabolic factors, statin use [hazard ratio (HR), 0.17; 95% confidence interval (CI), 0.04-0.70] and hypercholesterolemia (HR, 0.46; 95% CI, 0.24-0.88 for total cholesterol ≥240 mg/dL) were associated with a decreased risk of liver cancer mortality, whereas body mass index (BMI) ≥30 kg/m² was associated with an increased risk of liver cancer mortality (HR, 2.46; 95% CI, 1.20-5.06). This study showed that statin use was associated with decreased liver cancer mortality when adjusting for cholesterol levels and BMI. This study found that hypercholesterolemia was independently associated with decreased liver cancer mortality regardless of statin use.


Chronic hepatitis B; hepatocellular carcinoma; mortality; cholesterol

MeSH Terms

Bias (Epidemiology)
Body Mass Index
Carcinoma, Hepatocellular
Cohort Studies
Follow-Up Studies
Hepatitis B, Chronic*
Hepatitis, Chronic*
Hydroxymethylglutaryl-CoA Reductase Inhibitors*
Liver Diseases
Liver Neoplasms*
National Health Programs
Retrospective Studies


  • Fig. 1 Cumulative liver cancer mortality according to (A) statin use, (B) total cholesterol (TC), and (C) body mass index (BMI). HCC, hepatocellular carcinoma.


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