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Objective Sustained virological response (SVR) in patients with hepatitis C virus (HCV) is associated with slower progression of cirrhosis. Likewise, statin treatment is associated with delayed cirrhosis progression, but most studies of statin use in chronic liver disease include patients with multiple disease aetiologies. We use a unique time-dependent analysis to evaluate the interplay between antiviral treatment and statin use and the risk of decompensated cirrhosis (DC) among patients with HCV over time.Methods Using data from the US-based retrospective Chronic Hepatitis Cohort Study, we evaluated the impact of time-varying antiviral treatment status and statin use on risk of DC after propensity score weighting for HCV treatment selection bias. We used a pseudo-observation approach to compress data into discrete time intervals using 1 year as the landmark interval (INT), where each ‘INT’ has a value of 0 (at index) through 15 (15 years postindex) or the date of last follow-up. Time from the index date to the event of incident DC was the main outcome of interest. Death was considered a competing risk.Results A total of 16 275 patients with HCV (with 93 343 intervals) were observed (2006–2018), with 1718 incidents of DC and 2398 deaths. By year 15, the proportion of patients without antiviral treatment decreased from 36% to 11%; statin use increased from 12% to 28%. Compared with no antiviral treatment, SVR was associated with reduced risk of DC (SVR: adjusted HR (aHR) 0.17, 95% CI 0.14 to 0.21). Statin use was also associated with lower risk of decompensation (aHR 0.68, 95% CI 0.58 to 0.80) independent of cirrhosis status; such reduced risks varied but were sustained across treatment status groups. Additional risk factors included body mass index >25, male sex and multiple comorbidities.Conclusions Both SVR and statin treatment were associated with reduced risk of decompensation in patients with HCV. These findings may inform clinical management to reduce the risk of DC among patients with HCV.