Statin Therapy for Dyslipidemia in MASLD Patients

Safety of Statins in MASLD Patients

Patients with MASLD are at increased risk for cardiovascular disease, which is their most common cause of death, making statin therapy an important intervention for risk reduction 1, 2
Despite common reluctance to use statins in patients with liver disease, multiple studies have established that statins are safe in these patients 1, 3
The American Association for the Study of Liver Diseases (AASLD) guidelines explicitly state that there is no evidence that MASLD/NAFLD patients are at higher risk for serious statin-induced liver injury than those without liver disease 1, 2

Several studies suggest that statins may actually improve liver biochemistries in patients with MASLD/NASH 1, 2
A post-hoc analysis of the GREACE cardiovascular outcomes study showed that statins significantly improved liver biochemistries and cardiovascular outcomes in patients with elevated liver enzymes likely due to NAFLD 1, 3

Statins should not be used in patients with decompensated cirrhosis 2
Statins should not be used specifically to treat NASH itself, as there are no randomized controlled trials with histological endpoints proving their efficacy for this purpose 1, 2

Dyslipidemia treatment should be considered within the overall framework of cardiovascular risk reduction in MASLD patients, and elevated liver enzymes alone should not prevent the use of statins when clinically indicated 1, 2
Assess cardiovascular risk and need for lipid-lowering therapy 2
If liver enzymes are elevated but <3 times ULN, proceed with statin therapy at standard doses 2
Reassess statin therapy once liver enzymes have improved if they are >5 times ULN 2