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Little is known about the benefits of statin use on liver cancer mortality among patients with chronic hepatitis B (CHB) consideringhypercholesterolemia and obesity. A nationwide retrospective cohort study was conducted using data from a Health ExaminationCohort of the National Health Insurance Service of Korea. Data on CHB patients with no other concurrent liver diseasewere acquired, and statin use was defined as a cumulative daily dose ≥28. A 3-year landmark analysis was performed to avoid immortaltime bias. Patients who started statin therapy within the landmark date were considered statin users. A Cox regressionanalysis was applied to assess associations between statin use and liver cancer mortality considering hypercholesterolemia andobesity. Among 13063 patients, 193 (1.5%) died of liver cancer during the mean follow-up period of 10.6 years. After adjusting fordemographic and metabolic factors, statin use [hazard ratio (HR), 0.17; 95% confidence interval (CI), 0.04–0.70] and hypercholesterolemia(HR, 0.46; 95% CI, 0.24–0.88 for total cholesterol ≥240 mg/dL) were associated with a decreased risk of liver cancer mortality,whereas body mass index (BMI) ≥30 kg/m2 was associated with an increased risk of liver cancer mortality (HR, 2.46; 95% CI,1.20–5.06). This study showed that statin use was associated with decreased liver cancer mortality when adjusting for cholesterollevels and BMI. This study found that hypercholesterolemia was independently associated with decreased liver cancer mortalityregardless of statin use.
