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Statin use is associated with lower prevalence of advanced liver fibrosis in patients with type 2 diabetes

      Highlights

      • NAFLD and advanced fibrosis are highly prevalent in US adults with type 2 diabetes.
      • Statin use was associated with lower odds of advanced liver fibrosis and cirrhosis.
      • The association was stronger among women and younger patients.
      • Clinical trials on the effect of statin therapy on liver histology are justified.

      Abstract

      Background

      Patients with type 2 diabetes (T2D) are at increased risk of both cardiovascular disease (CVD) and advanced liver fibrosis related to non-alcoholic fatty liver disease (NAFLD). Statin use is known to reduce the incidence of CVD while evidence on an effect on NAFLD severity is limited.

      Methods

      This is a cross-sectional study performed with data from the 2017–2018 cycle of the National Health and Nutrition Examination Survey (NHANES). The target population consisted in adult patients with T2D and reliable vibration-controlled transient elastography (VCTE) results. Presence of liver fibrosis and steatosis were assessed by the median values of liver stiffness measurement (LSM) and controlled attenuation parameter (CAP), respectively. Patients with evidence of viral hepatitis and significant alcohol consumption were excluded. Logistic regression analysis was performed to evaluate the association between statin treatment and both steatosis and advanced (≥F3) liver fibrosis after adjustment for potential confounders.

      Results

      The study population consisted in 744 patients (age: 61 ± 1 years, BMI: 33.3 ± 0.5 kg/m2). NAFLD (CAP≥274 dB/m) was present in 74.9% of patients (95% CI 69.2–79.8) and 14.5% (95% CI 10.8–19.2) had advanced fibrosis (LSM ≥ 9.7 kPa). After adjustment for age, sex, race-ethnicity, BMI, albumin, total cholesterol, HbA1c, triglycerides and liver enzymes, statin use was associated with lower odds of advanced fibrosis (OR 0.35, 95% CI 0.13–0.90, p = 0.03). No significant interaction was found between statin use and steatosis.

      Conclusion

      Given the absence of approved therapies for NAFLD-fibrosis, it would be reasonable to initiate specific randomized controlled trials with statins.

      Keywords

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