Prescribing Statins to Patients with Nonalcoholic Fatty Liver Disease: Real Cardiovascular Benefits Outweigh Theoretical Hepatotoxic Risk

Abstract

Statins are among the most widely prescribed drugs in the western world and play a significant role in reducing cardiovascular risk. However, concern regarding their hepatic safety profile has meant that patients with concurrent liver pathology are often denied such benefits. In this review we consider the evidence for and against the prescription of statins to patients with nonalcoholic fatty liver disease, a group typically associated with high cardiovascular risk. Contrary to current opinion, we find that there is considerable evidence for and little evidence against the prescription of statins to this population and suggest that the guidelines advising against their use in these patients should be reviewed.

3-hydroxyl-3-methylglutaryl coenzyme A reductase inhibitor use in chronic liver disease: A therapeutic controversy

“…7,10 In addition, the NLA Statin Safety Assessment Task Force stated that routine aminotransferase monitoring in asymptomatic patients receiving statin therapy will unlikely identify these patients and that the risk and costs of monitoring outweigh the likelihood of detecting a statininduced adverse hepatic effect. 7,8 This recommendation was not only based on the rare incidence of liver failure but also because of the lack of any data supporting routine liver monitoring as an effective mode for identifying liver damage attributable to statin therapy. 6 A relationship between chronic liver aminotransferase elevations and histological liver injury has not been identified in patients by the use of statins.…”

“…13 One of the most concerning aspects of NAFLD is the increased incidence of CVD. 8,11 Because of the strong association with other comorbid conditions such as obesity, T2DM, and hyperlipidemia, patients with NAFLD have a high prevalence of cardiovascular risk factors as well as a greater risk of mortality from CVD. 8,11 NAFLD has been connected to a wide spectrum of vascular disease, such as endothelial dysfunction, intima-media thickening, and atherosclerotic plaque formation.…”

“…8,11 Because of the strong association with other comorbid conditions such as obesity, T2DM, and hyperlipidemia, patients with NAFLD have a high prevalence of cardiovascular risk factors as well as a greater risk of mortality from CVD. 8,11 NAFLD has been connected to a wide spectrum of vascular disease, such as endothelial dysfunction, intima-media thickening, and atherosclerotic plaque formation. 1,11 Statins continue to be the most effective currently available agents for the management of dyslipidemia and prevention of CVD.…”

“…3,4 The lack of a specific mechanism for statin-induced liver injury supports the belief that it is idiosyncratic in nature. 8 The Merck Worldwide Adverse Event Database reviewed 232 cases of acute liver failure associated with lovastatin and found an estimated risk of fulminant liver failure to be 2 per 1 million patients. 5,9 Moreover, 51,741 liver transplantations were performed in the United States from 1990 to 2002 and of those, three cases were attributed to statin therapy.…”

“…12 NAFLD resembles alcohol-induced liver disease but develops in individuals who are not heavy drinkers or in the absence of alcohol consumption. 8,13 The most common conditions associated with NAFLD are obesity, type 2 diabetes mellitus (T2DM), and hyperlipidemia. 1,[11][12][13] Consequently, the incidence of NAFLD is increasing in parallel with the growing prevalence of these conditions.…”