Statin use and the risk of liver-related events in older adults with steatotic liver disease

Statins are widely used for cardiovascular prevention, yet their hepatic benefits in older adults with steatotic liver disease (SLD) remain uncertain, particularly regarding liver-related events (LREs) and the modifying role of cardiometabolic risk factors (CMRFs). This retrospective cohort study used data from the Korean National Health Insurance Service-Senior cohort, comprising 125,926 adults aged ≥ 60 years with fatty liver index ≥ 30, followed from 2011 to 2019. Participants with prior liver disease or LREs at baseline were excluded. Cumulative statin exposure quantified as cumulative defined daily dose (cDDD) and categorized as non-use, 1 cDDD to 89 cDDD, 90 cDDD to 364 cDDD, and ≥ 365 cDDD; statin intensity classified as low, moderate, or high. The primary outcomes were incident LREs (primary liver cancer, liver cirrhosis, and decompensated cirrhosis) identified using validated ICD-10 codes. Associations were assessed using Fine and Gray competing-risk models and expressed as subdistribution hazard ratios (SHRs). During a median follow-up of 9 years, 3,445 LREs occurred over 1,054,343 person-years. Statin use was associated with a dose-dependent reduction in LRE risk. Compared with non-users, participants with ≥ 365 cDDD had the lowest risk of total LREs (SHR, 0.69; 95% CI, 0.61–0.78), primary liver cancer (SHR, 0.63; 95% CI, 0.52–0.76), and liver cirrhosis (SHR, 0.66; 95% CI, 0.57–0.77). Moderate- to high-intensity statin conferred greater protection than low-intensity statin. Statin therapy was associated with a significant and dose-dependent reduction in the risk of LREs among older adults with SLD, including those aged ≥ 75 years.