Oral 1 Diabetes Mellitus and Metabolic Syndrome: Independent Risk Factors for Hepatocellular Carcinoma (HCC)
Author Insight from Allison J. Kasmari, MD, Penn State, Milton S. Hershey Medical Center
What’s new here and important for clinicians?
Diabetes mellitus and metabolic syndrome are common medical conditions that increase the risk of various comorbidities, including cardiovascular disease and stroke. Until now, the major identified risk factors for hepatocellular carcinoma (HCC) have been hepatitis C infection and cirrhosis.
Analysis of MarketScan database indicates that individuals with diabetes mellitus, metabolic syndrome, hypertension, and hyperlipidemia , regardless of presence of hepatitis C, were more likely to develop hepatocellular carcinoma than age and sex matched controls. Medications commonly used to treat diabetes mellitus and hyperlipidemia were also analyzed.
It appears that tighter glycemic control in the setting of diabetes mellitus was protective against developing hepatocellular carcinoma. Interestingly, individuals with hyperlipidemia that were on lipid-lowering agents seemed to have the highest rate of development of hepatocellular carcinoma.
This retrospective study identifies a new set of risk factors for the development of hepatocellular carcinoma. Further research with prospective analyses of risk factors, including obesity, diabetes, hypertension, and hyperlipidemia, are required to further characterize the contribution of each factor to the development of hepatocellular carcinoma.
What do patients need to know?
Your primary care doctor has likely counseled you about the potential dangers of uncontrolled diabetes, high blood pressure, and high cholesterol. Left without appropriate treatment, these diseases increase the risk of heart attacks, strokes, and kidney disease, just to name a few. There is now one more reason to adequately control your diabetes.
A recent review of patients with hepatocellular carcinoma, or primary liver cancer, shows that individuals with diabetes, high blood pressure, and high cholesterol are more likely to develop primary liver cancer than those patients without these conditions.
Until now, the largest identified risk factor for developing primary liver cancer has been hepatitis C infection. Our analysis indicates that patients with diabetes, high cholesterol, and high blood pressure have increased risk of developing primary liver cancer, even without hepatitis C infection. Further review of these cases indicates that medications which more tightly control diabetes may offset the increased risk associated with the disease, and in some cases were protective against developing primary liver cancer.
Allison J. Kasmari, MD, Penn State, Milton S. Hershey Medical Center
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