IDDF2024-ABS-0430 Impact of hepatic steatosis on low-density lipoprotein cholesterol response to statins

<h3>Background</h3> Metabolic dysfunction-associated steatotic liver disease (MASLD) is currently the most common chronic liver disease worldwide. This study aimed to compare the low-density lipoprotein cholesterol (LDL-C) response to statin treatment among patients with and without hepatic steatosis. <h3>Methods</h3> Data collected from a cross-sectional population study in Hong Kong recruiting subjects aged 18 to 70 years from the community from May 2008 to September 2010 by random selection using the government census database were examined. Individuals who used statins and had an available LDL-C measurement before and after statin use were included. Statin response was defined as the decrease between pre-statin LDL-C level and LDL-C levels over 3 months, 6 months, and 12 months, modelled using multivariable linear mixed models. A prolonged follow-up of 10 years was also examined. <h3>Results</h3> Among 922 community 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 is 0.50±0.32 units. The analyses over 3, 6, and 12 months revealed no significant association between hepatic steatosis and statin response. In the 3-month analysis, hepatic steatosis showed a non-significant association with poorer statin response (less LDL-C reduction of 0.0508 mmol/L per year [95% CI -0.1070–0.2089], p=0.530). Similarly, hepatic steatosis did not exhibit a significant association with statin response in the 6-month analysis (0.0470 [95% CI -0.0194–0.1135], p=0.166) and in the 12-month analysis (0.0032 [95% CI -0.0270–0.0335], p=0.831). However, in the full linear mixed model including age, sex, defined daily dose of statins, other lipid-lowering drugs, and diabetes mellitus, hepatic steatosis showed a significant association with poorer statin response over 10 years (0.0263 [95% CI 0.0072–0.0454], p=0.007) (IDDF2024-ABS-0430 Figure 1, IDDF2024-ABS-0430 Table 1). <h3>Conclusions</h3> The association between hepatic steatosis and poorer LDL-C response to statins, if any, is not clinically significant. Patients with hepatic steatosis are hence recommended to receive a standard dose of statin according to clinical indications.