Cholesterol absorption inhibitors reduced the risk of liver cancer
A large-scale study by US scientists has found that taking cholesterol absorption inhibitors is associated with a reduced risk of liver cancer. They also found partial evidence that taking bile acid sequestrants could potentially increase this risk. The results of the analysis are published in the journal Cancer.
Chronic infection with hepatitis B and hepatitis C virus, exposure to aflatoxins, alcohol abuse, tobacco smoking and a constellation of metabolic disorders including non-alcoholic fatty liver disease, obesity and type 2 diabetes mellitus are considered major risk factors for liver cancer. Hypolipidaemic drugs that normalise the lipid profile, particularly of low-density lipoproteins, can potentially reduce the risk of liver cancer.
Numerous studies show that statins, which inhibit the activity of the enzyme HMG-CoA reductase and thus reduce the synthesis of cholesterol, can reduce the risk of liver cancer. However, the extent to which other hypolipidaemic cholesterol-lowering drugs are associated with a reduced risk of liver cancer is poorly understood. In particular, the effects of cholesterol absorption inhibitors, bile acid sequestrants, fibrates, niacin, and omega-3 fatty acids are poorly understood. Although the use of these drugs has declined since the introduction of statins into widespread clinical practice, they are prescribed in cases of intolerance to statins or in certain disorders of lipid metabolism.
A research team led by Katherine McGlynn of the National Cancer Institute studied the association between five hypolipidaemic drugs and the risk of liver cancer. To do this, they used data from the Clinical Practice Research Centre, which covers about seven per cent of the UK population. The study included patients seen between 1988 and 2019. The average age of the participants was 69.1 years, of which 70.1 per cent were male.
As expected, liver cancer patients (3,719) were more likely than comparable control patients (1,876) to have ever smoked, have a high body mass index, have type 2 diabetes, and be infected with hepatitis B or C virus. They were also more likely to have alcohol use disorders and chronic liver disease. In adjusted analyses, use of cholesterol absorption inhibitors was associated with a reduced risk of liver cancer (hazard ratio 0.69). The association persisted when adjusted for diabetes and chronic liver disease status.
In contrast to cholesterol absorption inhibitors, continued use of bile acid sequestrants appeared to be associated with an increased risk of liver cancer (hazard ratio 5.31), which was most evident with current use (hazard ratio 13.08). However, when adjusting for type 2 diabetes mellitus, this risk was no longer statistically significant. As for fibrates, niacin and omega-3 fatty acids, these drugs had no effect on the risk of liver cancer.
Scientists conclude that the use of cholesterol absorption inhibitors may be associated with a reduced risk of liver cancer. However, further research is needed to confirm the results of this study and to clarify more precisely the relationship between other hypolipidaemics and the risk of liver cancer.