Statin use is associated with a reduced risk for the development and progression of non-alcoholic fatty liver disease (NAFLD), particularly among individuals with a lower atherosclerotic cardiovascular disease (ASCVD) risk, according to study findings published in the Journal of Clinical Endocrinology and Metabolism.
Cardiovascular disease (CVD) is the leading cause of death among patients with NAFLD -- the most common chronic liver disease globally. Despite the widespread use of statins for lowering low-density lipoprotein (LDL) cholesterol and reducing CVD risk, their effects on NAFLD are not well understood.
To ascertain the relationship between statin use and NAFLD outcomes, researchers sourced data from the Kailuan Study, a Chinese prospective cohort focused on chronic non-communicable diseases. Participants aged 18 to 79 years with an indication for statin use between 2010 and 2017 were included, whereas individuals with hepatitis B, excessive alcohol consumption, or liver cirrhosis were excluded.
The cohort was divided into non-NAFLD and NAFLD patients, with the latter further classified into mild and moderate to severe NAFLD based on ultrasound diagnosis. Statin use was tracked through electronic medical records and biennial self-reported surveys.
"[S]tatin use may decrease the risk of NAFLD occurrence and progression, and the negative association became more evident with longer low or moderate ASCVD risk.
Primary outcomes included NAFLD occurrence, regression, and progression across the entire cohort. Propensity score matching was used to balance baseline characteristics between statin users and nonusers.
The study included 1183 statin users and 20,046 nonusers. Prior to propensity score matching, statin users were generally older, less likely to smoke or drink, and more likely to have higher body mass index (BMI), systolic blood pressure, and c-reactive protein levels but lower LDL cholesterol, triglycerides, and alanine transaminase (ALT) levels than nonusers. Both groups comprised 809 individuals after matching.
Statin users had a significantly lower incidence of NAFLD than nonusers (87.4 vs 106.4 per 1000 person-years; P <.001). This protective effect was stronger among those with cumulative statin use of at least 2 years (hazard ratio [HR], 0.56; 95% CI, 0.46-0.69).
Among 12,818 participants with mild NAFLD at baseline, statin users had a lower risk for NAFLD progression than nonusers (60.7 vs 75.5 per 1000 person-years; P <.001). The risk reduction was significant for both short-term and long-term statin users, with stronger protection observed among those using statins for at least 2 years (HR, 0.52; 95% CI, 0.30-0.90).
Although progression of NAFLD was slightly halted among long-term users, statin use did not lead to any regression of NAFLD. The incidence of regression was similar between statin users and nonusers, with no meaningful effect observed after adjustment for the duration of statin use.
Among individuals with low or moderate ASCVD risk, statin use demonstrated a protective effect on NAFLD occurrence (HR, 0.74; 95% CI, 0.66-0.82) and progression (HR, 0.68; 95% CI, 0.57-0.80). This protective effect was not observed among those with high or very high ASCVD risk.
Study limitations include the exclusion of advanced diagnostic methods for NAFLD diagnosis and the absence of data on adherence to statin prescriptions or other cholesterol-lowering drugs.
This article originally appeared on Endocrinology Advisor
References:
Feng B, Li F, Lan Y, et al. Statin use and development and progression of non-alcohol fatty liver disease based on ultrasonography: a cohort study. J Clin Endocrinol Metab. Published online August 16, 2024. doi:10.1210/clinem/dgae546