Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyMay 2025
In an observational study, statins were associated with lower risk for these outcomes among patients with chronic liver disease.
Observational studies have suggested that patients with chronic liver disease who take statins have lower risk for hepatocellular carcinoma (HCC; e.g. NEJM JW Gastroenterol Oct 2019 and Ann Intern Med 2019; 171: 318-327). Many of these studies, however, were from outside the USA and focused on patients with specific causes of liver disease, such as viral hepatitis.
To better understand this association, researchers used data from 10 Boston hospitals to study 16,500 patients with various types of chronic liver disease (primarily metabolic dysfunction associated steatotic liver disease [MASLD], viral hepatitis and alcoholic hepatitis). Patients (age, 40 years and older) had intermediate or high-risk fibrosis-4 (FIB-4) scores. Those who used statins had significantly lower 10-year cumulative incidence of hepatocellular carcinoma (HCC; 3.8% vs 8.0%) and were less likely to develop hepatic decompensation (10.6% vs 19.5%) than were nonusers.
At baseline, statin users had more comorbidities and higher FIB-4 scores than nonusers; after adjusting for these characteristics, differences were smaller but remained statistically significant. Of note, lowered HCC incidence with statins was similar among patients with and without MASLD.
Comment: Statins are thought to prevent liver disease progression and hepatocellular carcinoma through ‘anti-inflammatory, antifibrotic, and antioxidant mechanisms’ – in other words, the mechanism is not yet understood fully. Regardless, statins appear to benefit patients with chronic liver disease from a variety of causes. Some people are hesitant to start statins in the presence of chronic liver disease, but this study suggests that statins are not only safe but also beneficial for many such patients.
Molly S. Brett, MD, Assistant Professor of Clinical Medicine, University of Colorado School of Medicine; Primary Care Physician, Rocky Mountain Regional VA Medical Center, Aurora, USA.
Choi J, et al. Statin use and risk of hepatocellular carcinoma and liver fibrosis in chronic liver disease. JAMA Intern Med 2025 Mar 17; e-pub (https://doi.org/10.1001/jamainternmed.2025.0115).
This summary is taken from the following Journal Watch titles: General Medicine, Cardiology, Ambulatory Medicine, Hospital Medicine.