In patients with metabolic dysfunction–associated steatotic liver disease (MASLD), the use of statins has been found to correlate with a decreased long-term risk of death from any cause, as well as a reduction in liver-related complications and slower progression of liver stiffness.
Research Approach: Despite the widespread indications for statin use in individuals with MASLD—particularly for those with cardiovascular disease—these medications are often underprescribed due to concerns over potential liver damage and muscle-related side effects. To better understand the implications of statin use in this population, researchers conducted an observational cohort study involving 7,988 MASLD patients (average age 53; 58.2% female). These patients underwent at least two vibration-controlled transient elastography tests across 16 centers located in the United States, Europe, and Asia.
Participants were divided into two groups based on their liver stiffness measurements: those with compensated advanced chronic liver disease (cACLD; liver stiffness ≥ 10 kPa) and those without cACLD (liver stiffness < 10 kPa). At the start of the study, 17% of participants were classified as having cACLD.
Statin medications used by participants included simvastatin, pravastatin, atorvastatin, rosuvastatin, lovastatin, fluvastatin, and pitavastatin. At the study’s outset, 40.5% of participants were taking statins.
Key Findings: The primary focus was on a composite outcome that included all-cause mortality and liver-related events such as cirrhosis, hepatocellular carcinoma, or liver-related death. Secondary outcomes measured changes in liver stiffness over a median follow-up period of 4.6 years.
Statin users experienced a 76.7% reduction in the risk of death from any cause and a 62% reduction in liver-related complications compared to non-users (both P < .001). Additionally, statin use was linked to a 46% lower risk of liver stiffness progression in the cACLD group and a 55% lower risk in the non-cACLD group, compared to those not taking statins (both P < .001). However, there was no significant link between statin use and a regression in liver stiffness.
Clinical Implications: The study authors concluded that “statin use could potentially mitigate cardiovascular disease morbidity and mortality, as well as slow the progression of liver stiffness in both cACLD and non-cACLD patients.”
Source: This research was led by Xiao-Dong Zhou of The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, and published online in the journal Gut.
Study Limitations: The researchers noted that the assessment intervals of patients might have influenced data interpretation, and the median follow-up period may be too short to fully assess chronic liver disease progression. Additionally, the presence of residual confounding factors in statin users could have resulted in an overestimation of the observed benefits.
Funding and Disclosures: The study was funded by the National Natural Science Foundation of China and the National Key R&D Program of China. Some authors disclosed receiving various fees, grants, and honoraria from pharmaceutical and medical device companies. Two researchers involved were employed by Echosens during the study.
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