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Angiotensin-converting enzyme inhibitors prevent liver-related events in nonalcoholic fatty liver disease

Xinrong Zhang1,2,3, Grace Lai-Hung Wong1,2,3, Terry Cheuk-Fung Yip1,2,3

  • 1Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.

Hepatology (Baltimore, Md.)
|December 23, 2021
PubMed
Abstract

Insights

Angiotensin-converting enzyme inhibitors (ACEIs) reduce liver cancer and cirrhosis risks in non-alcoholic fatty liver disease (NAFLD) patients. Angiotensin receptor blockers (ARBs) showed no significant benefit, but ACEIs were particularly effective in patients with chronic kidney disease (CKD).

Area of Science:

  • Hepatology and Gastroenterology
  • Cardiovascular Pharmacology
  • Nephrology

Background:

  • Animal models suggest Angiotensin-converting enzyme inhibitors (ACEIs) and Angiotensin receptor blockers (ARBs) can inhibit liver fibrogenesis.
  • Non-alcoholic fatty liver disease (NAFLD) is a growing concern with potential for severe liver complications.
  • The impact of ACEI/ARB use on liver cancer and cirrhosis in NAFLD patients requires clinical evaluation.

Purpose of the Study:

  • To investigate the association between ACEI/ARB use and the risk of liver-related events (LREs) in patients with NAFLD.
  • To specifically assess the impact on liver cancer incidence and cirrhosis complications.
  • To explore potential differential effects of ACEIs versus ARBs and the influence of comorbidities like chronic kidney disease (CKD).

Main Methods:

  • Retrospective, territory-wide cohort study involving 12,327 adult NAFLD patients diagnosed between 2000 and 2014.
  • Patients were categorized based on ACEI or ARB treatment (≥6 months).
  • Propensity score weighting was used to analyze the primary endpoint: liver-related events (liver cancer and cirrhosis complications).

Main Results:

  • ACEI treatment was significantly associated with a reduced risk of liver-related events (LREs), including liver cancer and cirrhosis complications (weighted SHR, 0.48; p < 0.001).
  • Angiotensin receptor blocker (ARB) treatment did not show a significant association with reduced LREs.
  • ACEI treatment demonstrated a greater risk reduction in patients with chronic kidney diseases (CKDs) compared to those without.

Conclusions:

  • ACEI treatment, not ARB treatment, is linked to a lower risk of liver-related events in NAFLD patients.
  • The protective effect of ACEIs is particularly notable in NAFLD patients who also have CKD.
  • These findings suggest a potential therapeutic role for ACEIs in managing liver disease progression in specific NAFLD populations.

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