Statins and Reduced Risk of Hepatocellular Carcinoma in Patients With Hepatitis C Virus Infection: Further Evidence Is Warranted

TO THEEDITOR: The population-based cohort study by Tsan et al 1 showed that statin use was associated with a significantly reduced risk of hepatocellular carcinoma (HCC) in patients with hepatitis C virus infection (adjusted hazard ratio, 0.53; 95% CI, 0.49 to 0.58). However, we would like to raise a significant issue. As the authors acknowledge, not all possible confounding factors were adjusted for, including body mass index,smoking,alcoholuse,andotherindicatorsofhealthandsocioeconomic status. On the other hand, a socioeconomic gradient in the use of and adherence to statin treatments has been well documented in the literature. 2-6 Inparticular,individualsofhighersocioeconomicclassesare more likely to be given a statin. A social gradient in statin use may reflect social inequalities in health care use or health care quality, as well as systematic differences in factors such as tobacco use, nutrition, physical activity, and obesity. Thus, socioeconomic inequalities in statin use may haveconfoundedtheobservedassociationbetweenstatinuseandtherisk of HCC in patients with hepatitis C virus infection, especially given that meta-analyses of randomized clinical trials have constantly shown that statinsdonotaffectcancerrisk. 7,8 Nevertheless,weagreethatstatinsmerit further study in high-risk populations to elucidate their potential role in HCC chemoprevention.