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


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.


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