The authors comment that statins are “underused in NAFLD patients, possibly due to the fear of statin-related hepatic damage.” This deprives patients of the potential benefits of these agents. They point out that recent recommendations suggest that statins are safe and beneficial in patients with NAFLD.12

Ezetimibe is reported to reduce lipid levels, insulin resistance and CVD risk and to improve liver tests and hepatic histology in NAFLD and NASH patients. The combination of a statin drug and ezetimibe may prove to be more beneficial than monotherapy with either drug.2

Fibrates can be helpful in treating atherogenic dyslipidemia, especially reducing TG and sdLDL levels in NAFLD patients. However, although they have been shown to improve liver tests, they have not been shown to improve steatosis or fibrosis.2


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Niacin may prevent or ameliorate hepatic steatosis through its reduction of oxidative stress and inflammation, but the data regarding its impact on liver fat content is “limited and conflicting.”2

Conclusions

The authors conclude that, overall, “a multifactorial intervention including lifestyle measures and drugs targeting dyslipidemia, hypertension, and dysglycemia represent the best therapeutic approach to treat NAFLD patients.” They review several promising therapeutic targets under investigation for treating NAFLD (Table 3), noting that further research is needed to explore these potential interventions.

References

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4.      Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012 Jun;55(6):2005-23.

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6.      Shah P, Mudaliar S. Pioglitazone: side effect and safety profile. Expert Opin Drug Saf. 2010 Mar;9(2):347-54.

7.      Ciudin A, Hernandez C, Simó R. Update on cardiovascular safety of PPARgamma agonists and relevance to medicinal chemistry and clinical pharmacology. Curr Top Med Chem. 2012;12(6):585-604.

8.      US Food and Drug Administration (FDA). FDA Drug Safety Communication: FDA eliminates the Risk Evaluation and Mitigation Strategy (REMS) for rosiglitazone-containing diabetes medicines. Available at: http://www.fda.gov/Drugs/DrugSafety/ucm476466.htm. Accessed: September 13, 2016.

9.      Shao N, Kuang HY, Hao M, et al. Benefits of exenatide on obesity and non-alcoholic fatty liver disease with elevated liver enzymes in patients with type 2 diabetes. Diabetes Metab Res Rev. 2014 Sep;30(6):521-9.

10.  Bi Y, Zhang B, Xu W, et al. Effects of exenatide, insulin, and pioglitazone on liver fat content and body fat distributions in drug-naive subjects with type 2 diabetes. Acta Diabetol. 2014 Oct;51(5):865-73.

11.  Moreira de Macêdo S, Guimarães TA, Feltenberger JD, Sousa Santos SH. The role  of renin-angiotensin system modulation on treatment and prevention of liver diseases. Peptides. 2014 Dec;62:189-96.

12.  Bays H, Cohen DE, Chalasani N, et al. An assessment by the Statin Liver Safety Task Force: 2014 update. J Clin Lipidol. 2014 May-Jun;8(3 Suppl):S47-57.