#Statin liver safety in non-alcoholic fatty #liver disease. A systematic review and metanalysis

Statin liver safety in non-alcoholic fatty liver disease (NAFLD) patients is not well defined. We analysed differences in liver function tests, including alanine transaminase aminotransferase (ALT), aspartate transaminase (AST), and gamma-glutamyl transpeptidase (GGT) in NAFLD patients treated or not with statins.

Methods
We performed a systematic review of MEDLINE via PubMed and EMBASE databases and metanalysis of clinical studies investigating levels of ALT, AST and GGT in NAFLD according to statin treatment. Mean difference (MD) and percentage MD were calculated between the two groups.

Results
We included 22 studies with 2,345 NAFLD patients. Overall, 16 were before-after interventional, 5 cross-sectional and 1 combined cross-sectional/interventional study. In all interventional studies, except one, patients had raised ALT, AST and GGT at baseline.

Interventional studies showed reduced ALT values with a MD reduction of -27.2 U/l (95%CI -35.25/-19.15) and a percentage MD reduction of -35.41% (95%CI -44.78/-26.04). Also, AST values were reduced after statin treatment in interventional studies with a MD of -18.82 U/l (95%CI -25.63/-12.02) (percentage -31.78% 95%CI -41.45/-22.11). Similarly, GGT levels were reduced after statin treatment with a MD of -19.93 U/l (95%CI -27.10/-12.77) (percentage -25.57% 95%CI -35.18/-15.97). Cross-sectional studies showed no difference in AST and GGT values between patients with and without statins.

Conclusion
In interventional studies, ALT, AST and GGT were reduced after statin treatment with a percentage mean difference of -35.41%, -31.78% and -25.57%, respectively, while observational studies showed a null effect suggesting a liver safety in NAFLD patients

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