Cholesterol-lowering therapy for the treatment of nonalcoholic fatty liver disease: an update : Current Opinion in Lipidology

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Therapy and clinical trials: Edited by Anton F. Stalenhoef and John Kastelein

Cholesterol-lowering therapy for the treatment of nonalcoholic fatty liver disease

an update

Musso, Giovannia; Cassader, Mauriziob; Gambino, Robertob

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Current Opinion in Lipidology 22(6):p 489-496, December 2011. | DOI: 10.1097/MOL.0b013e32834c37ee


Purpose of review 

To review recent human trials assessing cholesterol-lowering agents in nonalcoholic fatty liver disease (NAFLD).

Recent findings 

Four randomized controlled trials (RCTs) assessed statins in NAFLD. In the only RCT with post-treatment biopsy, simvastatin did not change liver histology. In the remaining RCTs, atorvastatin was well tolerated, significantly improved radiological/biochemical markers of steatosis and plasma lipids, with neutral effects on glucose metabolism; in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) study, atorvastatin reduced incident cardiovascular disease compared with both untreated NAFLD patients and with statin-treated patients without NAFLD. Ezetimibe was evaluated in two uncontrolled trials and two RCTs, consistently improving liver histology and plasma lipids, whereas glucose metabolism was generally unaffected; however, HbA1c increased with ezetimibe in one RCT.


From the analysis of available trials, it emerges that cholesterol-lowering agents may considerably benefit NAFLD patients. Statins are well tolerated, and atorvastatin improved surrogate markers of liver disease, whereas their effect on liver histology is unknown. Furthermore, the GREACE study was the first trial to show clinical benefit from the use of a pharmacological agent in NAFLD. Ezetimibe improved liver histology. The benefit of combination therapy, as well as the safety on glucose metabolism, need further evaluation.

© 2011 Lippincott Williams & Wilkins, Inc.

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