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Statins decrease overall mortality and cancer related mortality but are underutilized in NAFLD: a longitudinal
Cheng Han Ng1, Margaret Lp Teng2, Nicholas Ws Chew1,3
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Expert Review of Gastroenterology & Hepatology
|August 29, 2022
Summary
Statins, used to treat high cholesterol, were underutilized in patients with nonalcoholic fatty liver disease (NAFLD). However, statin use was linked to lower overall and cancer mortality, despite no significant cardiovascular benefit observed.
Area of Science:
- Hepatology
- Cardiology
- Public Health
Background:
- Nonalcoholic fatty liver disease (NAFLD) is a prevalent chronic liver condition.
- NAFLD is linked to dyslipidemia and increased cardiovascular mortality.
- Statin underutilization is common in NAFLD patients despite being a first-line hyperlipidemia treatment.
Purpose of the Study:
- To investigate the utilization of statins in patients with NAFLD.
- To examine the association between statin use and mortality outcomes in NAFLD patients.
Main Methods:
- Utilized National Health and Nutrition Examination Survey (NHANES) data from 1999-2018.
- Included 12,538 NAFLD patients, with 6,452 indicated for hyperlipidemia treatment.
- Employed survival analysis for longitudinal outcome assessment.
Main Results:
- Statin usage varied by risk, highest in high-risk (44.28%) and lowest in low-risk (8.48%) individuals.
- Statin use was associated with significantly lower overall mortality (HR: 0.87) and cancer-related mortality (SHR: 0.73).
- No significant reduction in cardiovascular-related mortality was observed.
Conclusions:
- Statins remain underutilized in NAFLD due to concerns about hepatotoxicity and unproven mortality benefits.
- Statin use in NAFLD patients demonstrated a significant reduction in overall and cancer-related mortality.
- The absence of a cardiovascular mortality reduction may be due to patient selection bias in treatment allocation.
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