Hepatic Steatosis and Low‐Density Lipoprotein Cholesterol Response After Statin Initiation: A Prospective Cohort Analysis
Kristopher Cho‐Hei Lau, Vincent Wai‐Sun Wong, Alice Pik‐Shan Kong, Grace Lai‐Hung Wong, Jimmy Che‐To Lai, Winnie Chiu‐Wing Chu, Terry Cheuk‐Fung YipABSTRACT
Background and Aims
Metabolic dysfunction–associated steatotic liver disease (MASLD) is strongly associated with dyslipidemia, which is a major risk factor for cardiovascular diseases and the leading cause of mortality in MASLD. This study aimed to compare the low‐density lipoprotein cholesterol (LDL‐C) response to statins in patients with and without hepatic steatosis.
Methods
We identified subjects from a population screening program for MASLD who were subsequently started on statins. Statin response was defined as the absolute decrease between prestatin LDL‐C level and LDL‐C levels from months 0 to 3 and from months 3 to 12, modelled using multivariable linear mixed models.
Results
Among 922 subjects who underwent proton‐magnetic resonance spectroscopy screening, 286 received statin during follow‐up, among whom 132 (46%) had hepatic steatosis (liver fat fraction ≥ 5%) at baseline. The mean defined daily dose of statins was 0.50 ± 0.32 units. The analysis on LDL‐C average change per month over 12 months revealed no significant association between hepatic steatosis and statin response. Hepatic steatosis showed a nonsignificant association with poorer statin response over months 0–3 (difference of 0.097 mmol/L per month vs. no hepatic steatosis, p = 0.231) and months 3–12 (−0.037 mmol/L per month, p = 0.141), which remained after adjusting for diabetes, BMI, defined daily dose of statin, use of other lipid‐lowering drugs, age, and sex.
Conclusions
The association between hepatic steatosis and poorer LDL‐C response to statins, if any, is not clinically significant. Patients with hepatic steatosis are recommended to receive a standard statin dose according to clinical indications.