NAFLD and Statins
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CORRESPONDENCE
NAFLD and Statins Vasilios G. Athyros1 · Niki Katsiki1 · Dimitri P. Mikhailidis2 Received: 23 June 2020 / Accepted: 18 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
We read with interest the paper by Labenz et al. on the relationship between nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH) and the risk of cardiovascular disease (CVD) in Germany [1]. The authors mention “The evidence underlines the importance of intensified modification of risk factors including the use of statins in patients with NAFLD and potentially screening for CVD.” Two survival studies with atorvastatin had a beneficial effect on both NAFLD and CVD [2, 3]. The GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) study [2] was a prospective, target-based study that randomly assigned 1600 patients with coronary heart disease to either “usual care” or “structured care” (with atorvastatin) aiming to reach the low-density lipoprotein cholesterol (LDL-C) goal of 8000 CVD patients), the CVD benefit of high atorvastatin dose compared with the more moderate regimen with simvastatin was greater in patients with mildly-to-moderately elevated baseline ALT than patients with normal baseline ALT [3]. We also carried out a biopsy-proven beneficial effects on NASH with rosuvastatin [4], and various other potent statins. Others also
* Vasilios G. Athyros [email protected] 1
School of Medicine, Aristotle University of Thessaloniki, Marmara 15, 55132 Thessaloníki, Greece
Department of Clinical Biochemistry, Royal Free Hospital, University College London, London, UK
2
showed biopsy-proven benefits of statin treatment in patients with NAFLD [5]. Potent statins alone or in combination (with ezetimibe) [6] could be potentially beneficial for both NAFLD/NASH treatment and CVD risk reduction.
Reply To the editor, We would like to thank Athyros and colleagues for their important comment on our recent analysis demonstrating an independent risk of nonalcoholic fatty liver disease (NAFLD) on the incidence of cardiovascular disease (CVD) [1]. The highlighted trials support the strong evidence that patients with NAFLD benefit from statin therapy. The primary benefit of statins relates to a decrease in mortality from CVD. These effects have been studied abundantly and include findings on legacy effects of statins for up to 15 years after the end of the trail [7] and benefits for patients aged 75 years and older [8]. As excess mortality in NAFLD is related to CVD as the number one cause of death, statins are an important aspect in the management of patients with NAFLD. The use of statins should not be discouraged even in patients with NAFLD and elevated transaminases. In our own experience, this is far from being clinical reality. The concern of statins-induced liver injury seems to be a major aspect in under-prescription of statins in patients with NAFLD. While hepatotoxicity from statins can be severe, overall it is a rare event [9]. Recent evidence indicating that
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