Statins may lower risk for NAFLD, not linked to ALT increase

BOSTON — Patients taking statins had a lower prevalence of nonalcoholic fatty liver disease than those who were not, with no impact on alanine aminotransferase as a result of treatment, in a study presented at The Liver Meeting.

Researchers assessed ultrasonography and statin prescription data on 2,578 patients (mean age 76.5 years) collected from the Rotterdam Study, a population-based cohort of elderly people. Fatty liver observed on ultrasonography without the presence of secondary causes was considered nonalcoholic fatty liver disease (NAFLD).

“Statin therapy is an effective treatment in patients with the metabolic syndrome, but the effect and safety of statins on NAFLD is not well established,” the researchers wrote. “We aimed to study the association of statin therapy with the presence of NAFLD, and elevated alanine aminotransferase (ALT) concentrations in a large cross-sectional population-based study.”

NAFLD was observed in 35% of the cohort. Statin use was more common among participants with NAFLD than those without (27% of patients compared with 23%; P=.03). Investigators determined an association between current statin use and lower NAFLD prevalence (OR=0.58; 95% CI, 0.40-0.83 compared with nonusers), but not with prior use (OR=0.96; 95% CI, 0.66-1.404), via multivariate analysis adjusting for factors including age, sex, statin dosage, metabolic syndrome, cardiovascular disease and consumption of alcohol. No association was observed between ALT levels and either prior (OR=1.39; 95% CI, 0.72-2.69) or current statin use (OR=1.05; 95% CI, 0.56-1.97).

The association between statin use and lower NAFLD prevalence grew stronger according to the duration of statin therapy (OR=0.76; 95% CI, 0.64-0.91 for 1 year of use). Researcher Edith M. Koehler,MD, gastroenterology and hepatology division, Erasmus MC University Hospital, in Rotterdam, Netherlands, told Healio.com that additional analysis has since been performed in patients who had used statins for more than 2 years, and that the association persisted.

“Often there’s concern that statins may not be good for patients with NAFLD because they may elevate ALT,” Koehler said. “Our findings [show] that statin use is not associated with an elevation of ALT, which suggests it’s safe to prescribe to patients with or without NAFLD. It may even be good to prescribe statins to patients with NAFLD who don’t have cardiovascular disease, because it may lower the prevalence of NAFLD.”

Disclosure: Researcher Harry L. Janssen received consulting fees from Roche, Merck, Gilead Sciences, Bristol-Myers Squibb, Novartis, Santaris, Medtronic, Abbott, and Debio, and grant/research support from Roche, Merck, Gilead Sciences, Bristol-Myers Squibb, Novartis, Santaris, Medronic, Anadys, Innogenetics, and Kirin.

For more information:

Koehler EM. P825: Association between statin use and Nonalcoholic Fatty Liver Disease in a population-based study. Presented at: The Liver Meeting 2012; Nov. 9-13, Boston.