Statin Therapy and Clinical Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Systematic Review and Meta-Analysis

Beyond their lipid-lowering effects, statins exert pleiotropic properties, including anti-inflammatory, antioxidant, and antifibrotic actions, which may confer therapeutic benefits in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). This systematic review and meta-analysis aimed to evaluate the impact of statin therapy on clinical outcomes in adults with MASLD. A comprehensive literature search was conducted across PubMed, Embase, Cochrane CENTRAL, Web of Science, and Scopus from inception through January 10, 2026. Observational studies and randomized controlled trials comparing statin therapy with placebo or no treatment in adults with MASLD were eligible for inclusion. Eight observational studies met the inclusion criteria and were included in the quantitative synthesis. The primary outcomes were hepatocellular carcinoma incidence, all-cause mortality, and liver-related mortality. Statin use was associated with a significantly lower risk of hepatocellular carcinoma (pooled risk ratio (RR) 0.56, 95% CI 0.45-0.71), all-cause mortality (pooled RR 0.81, 95% CI 0.72-0.91), and liver-related mortality (pooled RR 0.54, 95% CI 0.37-0.79). Moderate to substantial heterogeneity was observed across studies. These findings suggest that statin therapy may confer meaningful hepatic and survival benefits in patients with MASLD, supporting their proactive use, particularly given their concomitant cardiovascular advantages. Nonetheless, the observational nature of the included studies underscores the need for large-scale randomized controlled trials to establish causality and define optimal treatment strategies.