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Sunday Poster Session

Category: Liver

P0959 - Impact of Lipophilic vs Hydrophilic Statin on the Risk of Hepatocellular Carcinoma: A US Cohort Propensity-Matched Study

Sunday, October 22, 2023
3:30 PM – 7:00 PM PT
Location: Exhibit Hall
Has Audio
ACG Outstanding Poster Presenter
Osama Hamid, MD, MRCPI1, Muhammad Talal Sarmini, MD2, Ahmed Eltelbany, MD, MPH1, Khaled Alsabbagh Alchirazi, MD1, Rama Nanah, MD1, Jamile Wakim-Fleming, MD1
1Cleveland Clinic, Cleveland, OH; 2Cleveland Clinic Foundation, Cleveland, OH

Introduction: The correlation between statin use and the risk of Hepatocellular Carcinoma (HCC) have been extensively investigated, revealing a potential protective effect. Our study aims to investigate the impact of lipophilic vs hydrophilic statin on the risk of HCC.

Methods: Using TriNetX, which aggregates >90 million patients' medical records, we identified adults and categorized into 4 groups: HBV cirrhosis, HBV without cirrhosis, HCV cirrhosis, and NASH cirrhosis. Each group was further divided into 3: patients on lipophilic statins only (Atorvastatin, Simvastatin, Lovastatin or Fluvastatin), patients on hydrophilic statins only (Rosuvastatin or Pravastatin), and those not on statin therapy (control). We excluded patients with Alcoholic liver disease, hereditary hemochromatosis, PBC, PSC, AIH, Wilson's disease and A1AT deficiency. We conducted 1:1 propensity score matching for demographics, co-morbidities and medications like aspirin, metformin, NSAIDs and HBV or HCV antivirals, relevant to respective group. In NASH group, additional variables like Vitamin E, pioglitazone, obesity medications and bariatric surgery were included. We calculated adjusted odds ratios (aOR) with 95% confidence intervals (CI) to assess the risk of HCC.

Results: Out of 26,145 patients with HBV cirrhosis, 1,429 (5.4%) were on lipophilic statin and 351 (1.3%) on hydrophilic statin. HBV without cirrhosis (n=116,296) had 14,071 (12.0%) on lipophilic statin and 3,346 (2.8%) on hydrophilic statin. HCV cirrhosis (n= 118,753) had 10,736 (9.0%) on lipophilic statin and 2,189 (1.8%) on hydrophilic statin. NASH cirrhosis (n= 138,296) had 21,236 (15.3%) on lipophilic statin and 6,403 (4.6%) on hydrophilic statin. Demographic and co-morbidity data were summarized in Table 1. After matching, lipophilic statin cohorts had a lower risk of HCC: HBV with cirrhosis (aOR 0.71 [0.57-0.88]), HBV without cirrhosis (aOR 0.49 [0.38-0.62]), HCV cirrhosis (aOR 0.70 [0.64-0.76]) and NASH cirrhosis (aOR 0.80 [0.73-0.87]). However, no significant difference in HCC risk in the hydrophilic statin cohorts: HBV cirrhosis (aOR 0.87 [0.58-1.32]), HBV without cirrhosis (aOR 0.68 [0.45-1.02]) and HCV cirrhosis (aOR 1.03 [0.87-1.22]). A protective effect was observed in the NASH cirrhosis cohort on hydrophilic statin (aOR 0.82 [0.72-0.94]), Figure 1.

Discussion: In our study, lipophilic statins showed a protective effect against hepatocellular carcinoma in HBV, HCV and NASH cirrhosis. Hydrophilic statins were only protective in NASH cirrhosis.



Figure: Figure 1: Adjusted odds ratio of HCC on lipophilic vs hydrophilic statins across the major HCC etiologies.
Table1: Demographics and characteristics of patients in cohort before matching
CohortPatients (% of Cohort)
GenderRace

Condition

MaleFemaleWhiteAAHispanicDMObesityHIVSmokingAlcohol
HBV with cirrhosis          

Lipo statin
N= 1,429

1,023

(71.6%)

405

(28.4%)

484

(33.9%)

300

(21%)

92

(6.4%)

626

(43.8%)

343

(24.0%)

68

(4.8%)

543

(37.9%)

91

(6.3%)

Hydro statin
N= 351

245
(69.8%)

106
(30.2%)

138
(39.3%)

58
(6.5%)

 19
(5.4%)		 141
(40.2%)

85
(24.2%) 

38
(10.8%)

96
(27.3%) 

 20
(5.7%)

HBV w/o Cirrhosis

          

Lipo statin
N= 14,071

8,568
(61.1%)

5,454
(38.9%)

5,526
(39.4%)

3,390
(24.2%)

772
(5.5%)

4,785
(34.1%)

3,031
(21.5%)

1,050
(7.5%)

4,842
(34.4%)

989
(7.0%) 

Hydro statin
N= 3,346

1,993
(59.6%)

1,349
(40.4%)

1,542
(45.6%)

724
(21.7%)

134
(4.0%)

969
(29.0%)

899
(26.8%)

448
(13.4%)

966
(28.8%)

 
120
(3.5%)
HCV Cirrhosis          

Lipo statin
N= 10,736

7,508
(70.0%)

3,222
(30%)

5,119
(47.7%)

3,667
(34.3%)

949
(8.8%)

4,917
(45.8%)

3,679
(34.2%)

536
(5.0%)

7,304
(68.0%)

1,065
(9.9%) 

Hydro statin
N= 2,189

1,481
(67.7%)

706
(32.3%)

1,158
(52.9%)

635
(29.0%)

192
(8.8%)

934
(42.7%)

549
(25.0%)

157
(7.2%)

1,150
(52.5%)

234
(10.6%) 

NASH Cirrhosis          

Lipo statin
N= 21,236

9,993
(47.1%)

11,229
(52.9%)

16,439
(77.5%)

1,295
(6.1%)

2,169
(10.2%)

13,453
(63.4%)

14,650
(68.9%)

140
(0.7%)

8,730
(41.1%)

 

1,337
(6.2%)

Hydro statin
N= 6,403

2,764
(43.2%)

3,636
(56.8%)

5,275
(82.4%)

270
(4.2%)

514
(8.0%)

3,814
(59.6%)

3,976
(62.0%)

60
(0.9%)

2,127
(33.2%)

229
(3.5%) 

  AA: African American; HIV: human immunodeficiency virus; DM: diabetes mellitus,  Lipo: lipophilic, Hydro: hydrophilic; NASH: non-alcoholic steatohepatitis.

Table: Table1: Demographics and characteristics of patients in cohort before matching


Disclosures:
Osama Hamid indicated no relevant financial relationships.
Muhammad Talal Sarmini indicated no relevant financial relationships.
Ahmed Eltelbany indicated no relevant financial relationships.
Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.
Rama Nanah indicated no relevant financial relationships.
Jamile Wakim-Fleming indicated no relevant financial relationships.


Osama Hamid, MD, MRCPI1, Muhammad Talal Sarmini, MD2, Ahmed Eltelbany, MD, MPH1, Khaled Alsabbagh Alchirazi, MD1, Rama Nanah, MD1, Jamile Wakim-Fleming, MD1. P0959 - Impact of Lipophilic vs Hydrophilic Statin on the Risk of Hepatocellular Carcinoma: A US Cohort Propensity-Matched Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.