STATIN THERAPY IN PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE AND CARDIOVASCULAR RISK

There are many data showing the efficacy and safety of statin therapy in patients with NAFLD and increased CVR but the question of its beneficial effect on NAFLD is still open. We evaluated the effects of long-term (mean period of five years) statin therapy in 100 patients with NAFLD with elevated liver enzymes and dyslipidemia. Coronary heart disease (CHD) was established only in three cases with diabetes mellitus (DM) type 2. The use of statins led to decrease of total cholesterol and LDL-cholesterol (p < 0.001), triglycerides (p < 0.05) and increase of HDL-cholesterol (p < 0.05). A reduction of liver enzymes levels was found, the most evident in GOT values (p < 0.01). Followup of the patients showed liver enzymes normalization in 36 subjects, permanent decrease in seven cases, and fluctuating elevation up to three times above the upper limit of normal in 50 cases. The significant increase of liver enzymes (2%) was related with the presence of severe degree of steatosis and diabetes. The temporary stop of statin use and reduction of the dose allowed the continuation of statin therapy. The levels of CRP and ferritin also decreased significantly (p < 0.05). The ultrasound degree of steatosis changed gradually. There were no significant changes in the values of BMI, blood glucose, HbAlc and the markers of insulin resistance. In seven cases with impaired glucose tolerance initially, a newly diagnosed DM was established. In conclusion, statin therapy in patients with NAFLD corrects dyslipidemia, decreases the risk for CHD and has additional beneficial effect on NAFLD and no effect on insulin resistance and development of DM type 2.