Published online Jun 14, 2015. doi: 10.3748/wjg.v21.i22.6820
Peer-review started: January 22, 2015
First decision: March 10, 2015
Revised: March 31, 2015
Accepted: May 7, 2015
Article in press: May 7, 2015
Published online: June 14, 2015
Non-alcoholic fatty liver disease (NAFLD) is considered to be an independent cardiovascular disease (CVD) risk factor. However, simple steatosis has a benign clinical course without excess mortality. In contrast, the advanced form of NAFLD, non-alcoholic steatohepatitis (NASH) with liver fibrosis increases mortality by approximately 70%, due to an increase in CVD mortality by approximately 300%. Chronic kidney disease (CKD) may be caused by NAFLD/NASH and it substantially increases CVD risk, especially in the presence of type 2 diabetes mellitus. Moreover, CKD may trigger NAFLD/NASH deterioration in a vicious cycle. NAFLD/NASH is also related to increased arterial stiffness (AS), an independent CVD risk factor that further raises CVD risk. Diagnosis of advanced liver fibrosis (mainly by simple non-invasive tests), CKD, and increased AS should be made early in the course of NAFLD and treated appropriately. Lifestyle measures and statin treatment may help resolve NAFLD/NASH and beneficially affect the CVD risk factors mentioned above.
Core tip: Non-alcoholic fatty liver disease (NAFLD) is an independent cardiovascular disease (CVD) risk factor. However, simple steatosis has a rather benign clinical course, while its advanced form, non-alcoholic steatohepatitis (NASH) substantially increases total mortality, mainly due to increased CVD events. In this review we propose the use of statin treatment for NASH, given its beneficial effect on NAFLD/NASH and CVD risk. There are data suggesting biopsy proven amelioration of NASH and normalization in liver ultrasonography and enzyme values as well as improvement of chronic kidney disease and arterial stiffness that usually accompany NASH and exacerbate CVD risk.