Statins underused in patients with NAFLD

WASHINGTON — Statins have been underused in patients with nonalcoholic fatty liver disease who had abnormal liver tests despite having appropriate indications for their use, especially among patients with concomitant diabetes, according to a study presented at Digestive Disease Week 2018.

“We’ve known for a long time that statins are safe in patients with underlying liver disease — this has been published for years — but what I noticed in clinical practice is that I’m still getting referrals for patients with elevated liver enzymes,” Sonal Kumar, MD, MPH, from the New York Presbyterian Hospital Cornell, told Healio Gastroenterology and Liver Disease. “Statins have a risk of hepatotoxicity, but the risk is not increased with patients with underlying liver disease. So, I wanted to find out if this is just something I’ve been seeing at my institution or if this is a more generalized issue.”

Kumar and colleagues accessed data from the National Health and Nutrition Examination Survey from 2005 to 2014 to evaluate the use of statins in patients with NAFLD. They selected all patients with diabetes and NAFLD who had a LDL higher than 130 mg/dL. The researchers defined abnormal liver tests as alanine aminotransferase higher than 40 IU/L.

Of the 136,833,627 patients included in the study, 74.6% had hyperlipidemia, of whom 93.5% were taking a statin. However, patients diagnosed with hyperlipidemia who had abnormal ALT were significantly less likely to take a statin (86.3% vs. 89.1%; P = .001).

Multivariate analysis including age and sex showed that abnormal ALT significantly decreased the odds of patients receiving statins if they had diabetes (OR = 0.75; 95% CI, 0.57-0.099), but not metabolic syndrome or hyperlipidemia.

“I think there’s a gap in knowledge that someone with underlying liver disease — specifically fatty liver disease — is not at a higher risk for hepatotoxicity than someone with no liver disease,” Kumar said. “The best thing to do is some form of education. We just have to keep trying to teach people. Hepatologists and GI doctors, we’re not the prescribing doctors; we need to reach out to primary care doctors and cardiologists.”

Kumar concluded that because the most common cause of morbidity and mortality in patients with fatty liver disease is cardiovascular events and statins reduce that risk, “this is a population that would really benefit from the use of statins.” – by Talitha Bennett

Reference :

Rosenblatt RE, et al. Abstract Su1511. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

Disclosure: Kumar reports she received consulting, speaking or teaching fees and served on review panels for AbbVie, Gilead Sciences and Intercept. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.