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Statins in Nonalcoholic Fatty Liver Disease and Steatohepatitis: Updated Review

  • Coronary Heart Disease (Ja Farmer, Section Editor)
  • Published:
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Abstract

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease that refers to the presence of hepatic steatosis without significant intake of alcohol. NAFLD is an asymptomatic disease that can progress to nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma. The most common cause of mortality in patients with NAFLD or NASH is cardiovascular disease (CVD). Currently, the treatment of NAFLD focuses on gradual weight loss and life style modifications. However, multifactorial treatment of NAFLD or NASH risk factors may be needed to reduce the likelihood of these patients developing CVD. This review discusses the mechanisms that link hyperlipidemia and NAFLD. In addition, the review focuses on the safety and efficacy of statins in patients with NAFLD or NASH, and their effect on the extent of hepatic steatosis and fibrosis based on human studies.

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References

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  1. Bugianesi E, Leone N, Vanni E, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002;123:134–40.

    Article  PubMed  Google Scholar 

  2. Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc. 1980;55:434–8.

    PubMed  CAS  Google Scholar 

  3. Angulo P. Nonalcoholic fatty liver diseases. N Eng J Med. 2002;346:1221–31.

    Article  CAS  Google Scholar 

  4. Marchesini G, Bugianesi E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003;37:917–23.

    Article  PubMed  Google Scholar 

  5. Marchesini G, Marzocchi R, Agostini F, Bugianesi E. Nonalcoholic fatty liver disease and metabolic syndrome. Curr Opin Lipidol. 2005;16:421–7.

    Article  PubMed  CAS  Google Scholar 

  6. Kral JG, Schaffner F, Pierson Jr RN, Wang J. Body fat topography as an independent predictor of fatty liver. Metabolism. 1993;42:548–51.

    Article  PubMed  CAS  Google Scholar 

  7. Assy N, Kaita K, Mymin D, Levy C, Roser B, Minuk G. Fatty infiltration of liver in hyperlipidemic patients. Dig Dis Sci. 2000;45:1929–34.

    Article  PubMed  CAS  Google Scholar 

  8. Azzout-Marniche D, Bécard D, Guichard C, Foretz M, Ferré P, Foufelle F. Insulin effects on sterol regulatory-element-binding protein-1c (SREBP-1c) transcriptional activity in rat hepatocytes. Biochem J. 2000;350:389–93.

    Article  PubMed  CAS  Google Scholar 

  9. Day CP, James OF. Steatohepatitis: a tale of two "hits". Gastroenterology. 1998;114:842–5.

    Article  PubMed  CAS  Google Scholar 

  10. Charlton M, Sreekumar R, Rasmussen D, Lindor K, Nair KS. Apolipoprotein synthesis in nonalcoholic steatohepatitis. Hepatology. 2002;35:898–904.

    Article  PubMed  CAS  Google Scholar 

  11. National Cholesterol Education Program. Second report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult treatment panel II). Circulation. 1994;89:1333–445.

    Article  Google Scholar 

  12. Nseir W, Shalata A, Marmor A, Assy N. Mechanisms linking nonalcoholic fatty liver disease with coronary artery disease. Dig Dis Sci. 2011;56:3439–49.

    Article  PubMed  CAS  Google Scholar 

  13. Tandra S, Vuppalanchi R. Use of statins in patients with liver disease. Curr Treat Options Cardiovasc Med. 2009;11:272–3.

    Article  PubMed  Google Scholar 

  14. Charles EC, Olson KL, Sandhoff BG, McClure DL, Merenich JA. Evaluation of cases of severe statin-related transaminitis within a large health maintenance organization. Am J Med. 2005;118:618–24.

    Google Scholar 

  15. Adiels M, Taskinen MR, Packard C, et al. Overproduction of large VLDL particles is driven by increased liver fat content in man. Diabetologia. 2006;49:755–65.

    Article  PubMed  CAS  Google Scholar 

  16. Nseir W, Nassar F, Assy N. Soft drinks consumption and nonalcoholic fatty liver disease. World J Gastroenterol. 2010;16:2579–88.

    Article  PubMed  CAS  Google Scholar 

  17. Abid A, Taha O, Nseir W, Farah R, Grosovski M, Assy N. Soft drink consumption is associated with fatty liver disease independent of metabolic syndrome. J Hepatol. 2009;51:918–24.

    Article  PubMed  CAS  Google Scholar 

  18. Leclercq IA, Horsmans Y. Nonalcoholic fatty liver disease: the potential role of nutritional management. Curr Opin Clin Nutr Metab Care. 2008;11:766–73.

    Article  PubMed  CAS  Google Scholar 

  19. Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000;21:697–738.

    Article  PubMed  CAS  Google Scholar 

  20. Ginsberg HN, Huang LS. The insulin resistance syndrome: impact on lipoprotein metabolism and atherothrombosis. J Cardiovasc Risk. 2000;7:325–31.

    PubMed  CAS  Google Scholar 

  21. • Nseir W, Mograbi J, Ghali M. Lipid-lowering agents in nonalcoholic fatty liver disease and steatohepatitis: human studies. Dig Dis Sci. 2012;57:1773–81. This review describes all human studies that examined the safety and efficacy of the statins and other lipid- lowering agents in patients with NAFLD, and the mechanisms linking hyperlipidemia and fatty infiltration.

    Article  PubMed  CAS  Google Scholar 

  22. Utzschneider KM, Kahn SE. The role of insulin resistance in nonalcoholic fatty liver disease. J Clin Endocrinol Metab. 2006;91:4753–61.

    Article  PubMed  CAS  Google Scholar 

  23. Mazzone T, Foster D, Chait A. In vivo stimulation of low-density lipoprotein degradation by insulin. Diabetes. 1984;33:333–8.

    Article  PubMed  CAS  Google Scholar 

  24. Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomized placebo-controlled trial. Lancet. 2002;360:7–22.

    Article  Google Scholar 

  25. Halcox JP, Deanfield JE. Beyond The laboratory: clinical implications for statin pleiotropy. Circulation. 2004;109((21 Suppl 1):II 42–8.

    Google Scholar 

  26. Weitz-Schmidt G. Statins as anti-inflammatory agents. Trends Pharmol Sci. 2002;23:482–6.

    Article  CAS  Google Scholar 

  27. Nseir W, Mograbi J, Abu-Elheja O, Bishara J, Assy N. The impact of prior long-term versus short-term statin use on the mortality of bacteraemic patients. Infection. 2012;40:41–8.

    Article  PubMed  CAS  Google Scholar 

  28. Nseir W, Diab H, Mahamid M, Abu-Elheja O, Samara M, Abid A, Mograbi J. Randomized clinical trial: simvastatin as adjuvant therapy improves significantly the Helicobacter pylori eradication rate-placebo-controlled study. Aliment Pharmacol Ther. 2012;36:231–8.

    Article  PubMed  CAS  Google Scholar 

  29. Lewis JH, Mortensen ME, Zweig S, Fusco MJ, Medoff JR, Belder R. Efficacy and safety of high-dose pravastatin in hypercholesterolemic patients with well-compensated chronic liver disease: results of a prospective, randomized, double-blind, placebo-controlled, multicenter trial. Hepatology. 2007;46:1453–63.

    Article  PubMed  CAS  Google Scholar 

  30. Chalasani N, Aljadhey H, Kesteron J, Murray MD, Hall SD. Patients with elevated liver enzymes are not at higher risk for statin hepatotoxicity. Gastroenterology. 2004;128:1287–92.

    Article  Google Scholar 

  31. Vuppalanchi R, Teal E, Chalasani N. Patients with elevated baseline liver enzymes do not have higher frequency of hepatotoxicity from lovastatin than those with normal baseline liver enzymes. Am J Med Sci. 2005;329:62–5.

    Article  PubMed  Google Scholar 

  32. Abel T, Feher J, Dinya H, Eldin MG, Kovacs A. Safety and efficacy of combined ezetemibe/simvastatin treatment and simvastatin monotherapy in patients with non-alcoholic fatty liver disease. Med Sci Monit. 2009;15:MS6–MS11.

    PubMed  CAS  Google Scholar 

  33. Nelson A, Torres DM, Morgan AE, Fincke C, Harrison SA. A pilot study using simvastatin in the treatment of nonalcoholic steatohepatitis: a randomized placebo-controlled trial. J Clin Gastroenterol. 2009;43:990–4.

    Article  PubMed  CAS  Google Scholar 

  34. Mihaila RG, Nedelcu L, Fratila O, Rezi EC, Domnariu C, Deac M. Effects of lovastatin and pentoxyphyllin in nonalcoholic steatohepatitis. Hepatogastroenterology. 2009;56:1117–21.

    PubMed  CAS  Google Scholar 

  35. Rallidis LS, Drakoulis CK, Parasi AS. Pravastatin in patients with nonalcoholic steatohepatitis: results of a pilot study. Atherosclerosis. 2004;174:193–6.

    Article  PubMed  CAS  Google Scholar 

  36. Hyogo H, Ikegami T, Tokushige K, et al. Efficacy of pitavastatin for the treatment of non-alcoholic steatohepatitis with dyslipidemia: an open–label, pilot study. Hepatol Res. 2011;41:1057–65.

    Google Scholar 

  37. Gomez-Dominguez E, Gisbert JP, Moreno-Monteagudo JA, García-Buey L, Moreno-Otero R. A pilot study of atorvastatin treatment in dyslipemidia, non-alcoholic fatty liver patients. Aliment Pharmacol Ther. 2006;23:1643–7.

    Article  PubMed  CAS  Google Scholar 

  38. •• Athyros VG, Tziomalos K, Gossios TD, et al. Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver test in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) study: a post-hoc analysis. Lancet. 2010;376:1916–22. This RCT, which contained a large number of participants (437), showed that atorvastatin was safe and improved liver function in patients suspected to have NAFLD.

    Article  PubMed  CAS  Google Scholar 

  39. Kiyici M, Gulten M, Gurel S, et al. Ursodeoxycholic acid and atorvastatin in the treatment of nonalcoholic steatohepatitis. Can J Gastroenterol. 2003;17:713–8.

    PubMed  Google Scholar 

  40. Athyros VG, Mikhaildis DP, Didangelos TP, et al. Effect of multifactorial treatment on non-alcoholic fatty liver disease in metabolic syndrome: a randomized study. Cur Med Res Opin. 2006;22:873–83.

    Article  CAS  Google Scholar 

  41. Georgescu EF, Georgescu M. Therapeutic options in non-alcoholic steatohepatitis (NASH). Are all agents alike? Results of preliminary study. J Gastrointestin Liver Dis. 2007;16:39–46.

    PubMed  Google Scholar 

  42. Kimura Y, Hyogo H, Yamagishi S, et al. Atorvastatin decreases serum levels of advanced glycation endproducts (AGEs) in nonalcoholic steatohepatitis (NASH) patients with dyslipidemia: clinical usefulness of AGEs as a biomarker for the attenuation of NASH. J Gastroenterol. 2010;45:750–7.

    Article  PubMed  CAS  Google Scholar 

  43. Samy W, Hassanian MA. Paraoxonase-1 activity, malondialdehyde and glutathione peroxidase in non-alcoholic fatty liver disease and the effect of atorvastatin. Arab J Gastroenterol. 2011;12:80–5.

    Article  PubMed  CAS  Google Scholar 

  44. • Foster T, Budoff MJ, Saab S, Ahmadi N, Gordon C, Guerci AD. Atorvastatin and antioxidants for the treatment of nonalcoholic fatty liver disease: the St Francis Heart Study randomized clinical trial. Am J Gastroenterol. 2011;106:71–7. This subgroup study from the St. Francis RCT shows that the combination therapy of atorvastatin and vitamin C and E improved hepatic steatosis, as assessed by CT scan.

    Article  PubMed  CAS  Google Scholar 

  45. Antonopoulos S, Mikros S, Mylonopoulou M, Kokkoris S, Giannoulis G. Rosuvastatin as a novel treatment of non-alcoholic fatty liver disease in hyperlipidemic patients. Atherosclerosis. 2006;184:233–4.

    Article  PubMed  CAS  Google Scholar 

  46. Nakahara T, Hyogo H, Kimura Y, Ishitobi T, Arihiro K, Aikata H, et al. Efficacy of rosuvastatin for the treatment of non-alcoholic steatohepatitis with dyslipidemia: an open-label, pilot study. Hepatol Res. 2012;42:1065–72.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to William Nseir.

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Nseir, W., Mahamid, M. Statins in Nonalcoholic Fatty Liver Disease and Steatohepatitis: Updated Review. Curr Atheroscler Rep 15, 305 (2013). https://doi.org/10.1007/s11883-012-0305-5

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