Reduced risk of hepatocellular carcinoma in the use of fibrate as an add-on to statin: A retrospective population-based cohort study

Abstract

Background This study investigated the reduced risk of hepatocellular carcinoma (HCC) by the use of fibrates as an add-on to statins. Methods This population-based cohort study was conducted from the Korean National Health Insurance Service from 2010 to 2019 in Korea. We compared the incidence of HCC between statin users and those taking fibrates and statins for dyslipidemia, matched using age, sex, and hypertriglyceridemia. Results We analysed 789,958 individuals, including 394,979 statin users and 394,979 who were matched users of combined fibrate-statin therapy. During the 1644,037.6 person-years of follow-up, 791 HCC cases were observed in the statin group, whereas 703 HCC cases were observed in the fibrate-statin group during 1646,939.6 person-years of follow-up. The HCC incidence rates per 1000 person-years were 0.48 and 0.43 in the statin and fibrate-statin groups, respectively. The risk of HCC was lower in the fibrate-statin group compared to the statin-only group in the unadjusted and adjusted models (hazard ratio [HR] 0.89 with 95 % confidence interval [CI]: 0.80-0.98 and adjusted HR [aHR] 0.74 with 95 % CI: 0.67-0.83). The reduction of HCC development by fibrate-statin increased as the duration of fibrate administration lengthened (aHR 0.76 with 95 % CI: 0.68-0.86 in the use of fibrate and statin for <1 year; and aHR 0.71 with 95 % CI: 0.61-0.82 for >1 year). Conclusions Fibrates as an add-on to statin were associated with a reduced risk of HCC compared to statins. Further prospective studies are needed to clarify the role of fibrate on the risk of HCC.