The Effect of Statin Therapy on Liver Enzymes and Fibrosis Progression in Patients With Coexisting Cardiovascular Disease and Non-alcoholic Fatty Liver Disease (NAFLD)

Background Non-alcoholic fatty liver disease (NAFLD) is a common liver condition often associated with cardiovascular disease (CVD). Statins, primarily used to manage cardiovascular risk, may also have potential benefits in improving liver function and slowing the progression of liver fibrosis in patients with coexisting CVD and NAFLD. Objective To assess the impact of statin therapy on liver enzyme levels (alanine aminotransferase (ALT), aspartate aminotransferase (AST)) and liver fibrosis progression in patients with both CVD and NAFLD, and to determine the potential dual benefits of statins for managing both liver and cardiovascular health. Methods This was a prospective, observational study conducted at Tabba Heart Institute, Karachi, from November 2023 to November 2024. It involves 253 patients with coexisting CVD and NAFLD. Of these, 152 patients were receiving statin therapy, while 101 patients were not. Liver enzyme levels (ALT, AST) and liver fibrosis were assessed at baseline and after 12 months of follow-up using non-invasive methods, including elastography and the NAFLD fibrosis score. Results Statin therapy was associated with a significant reduction in ALT and AST levels in the statin group, with ALT decreasing from 43.2±18.6 U/L to 35.8±14.2 U/L (p<0.01) and AST decreasing from 38.1±15.3 U/L to 30.7±12.1 U/L (p=0.03). Additionally, the statin group experienced less fibrosis progression, with 18% showing regression of fibrosis compared to only 4% in the non-statin group (p<0.01). Statins also improved lipid profiles, significantly reducing total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels (p<0.01). The incidence of cardiovascular events in the statin group declined significantly, with myocardial infarction and stroke rates dropping from 10% to 4% (p<0.05). Conclusion Statin therapy in patients with coexisting CVD and NAFLD resulted in significant improvements in liver enzymes, slower progression of liver fibrosis, and favorable changes in lipid profiles and cardiovascular outcomes.