Prescription of statins in suspected non-alcoholic fatty liver disease and high cardiovascular risk, a population-based study

Eline H van den Berg; Alba A B Wolters; Robin P F Dullaart; Han Moshage; David Zurakowski; Vincent E de Meijer; Hans Blokzijl

doi:10.1111/liv.14116

Prescription of statins in suspected non-alcoholic fatty liver disease and high cardiovascular risk, a population-based study

Liver Int. 2019 Jul;39(7):1343-1354. doi: 10.1111/liv.14116. Epub 2019 Jun 10.

Authors

Eline H van den Berg^{1

2}, Alba A B Wolters^{1

3}, Robin P F Dullaart², Han Moshage^{1

3}, David Zurakowski⁴, Vincent E de Meijer⁵, Hans Blokzijl¹

Affiliations

¹ Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
² Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³ Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁴ Departments of Anesthesiology and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
⁵ Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Abstract

Background & aims: The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing, with concomitant high incidence of lipoprotein abnormalities. Cardiovascular disease (CVD) is the main cause of death in subjects with NAFLD and management of dyslipidaemia is pivotal for prevention. We aimed to determine cardiovascular risk and indication for statin therapy in subjects with NAFLD.

Methods: A cross-sectional analysis of the population-based Lifelines Cohort Study of 34 240 adult individuals. Subjects with reported use of lipid-lowering drugs were excluded. Suspected NAFLD was defined as Fatty Liver Index (FLI) ≥60 and advanced hepatic fibrosis as NAFLD fibrosis score (NFS) >0.676. Cardiovascular risk and indication for statin therapy were defined according to the European Society of Cardiology and European Atherosclerosis Society Guideline for the Management of Dyslipidaemias.

Results: FLI ≥ 60 was present in 7067 (20.6%) participants and coincided with increased prevalence of type 2 diabetes mellitus, metabolic syndrome, CVD and impaired renal function (all P < 0.001). 10-year predicted cardiovascular risk was significantly increased in subjects with elevated FLI and NFS (both P < 0.001). Indication for statin use was significantly increased in subjects with FLI ≥ 60 (31.0% vs 15.6%, P < 0.001) and NFS > 0.676 (73.2% vs 30.6%, P < 0.001). In multivariable analyses, FLI ≥ 60 (OR 1.26, 95%CI: 1.13-1.41, P < 0.001) and NFS > 0.676 (OR 5.03, 95%CI: 2.76-9.17, P < 0.001) were independent predictors for indication regarding statin therapy.

Conclusions: Because of increased cardiovascular risk, substantial proportions of subjects with suspected NAFLD and/or fibrosis have an indication for lipid-lowering treatment and could benefit from statin therapy.

Keywords: NAFLD fibrosis score; cardiovascular risk; dyslipidaemia; fatty liver Index; non-alcoholic fatty liver disease; statin therapy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cardiovascular Diseases / epidemiology*
Cardiovascular Diseases / etiology*
Cohort Studies
Cross-Sectional Studies
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Liver Function Tests
Logistic Models
Male
Middle Aged
Netherlands / epidemiology
Non-alcoholic Fatty Liver Disease / complications
Non-alcoholic Fatty Liver Disease / drug therapy*
Prevalence
Risk Factors
Severity of Illness Index

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors