The use of statins alone, or in combination with pioglitazone and other drugs, for the treatment of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis and related cardiovascular risk. An Expert Panel Statement

Athyros, Vasilios G.; Alexandrides, Theodore K.; Bilianou, Helen; Cholongitas, Εvangelos; Doumas, Michael; Ganotakis, E.S.; Goudevenos, John; Elisaf, Moses; Germanidis, Georgios; Γιουλεμέ, Όλγα; Karagiannis, Asterios; Karvounis, Charalambos; Katsiki, Niki; Kotsis, Vasilios; Kountouras, Jannis; Liberopoulos, Evangelos; Pitsavos, Christos; Polyzos, Stergios A.; Rallidis, Lοukianos S.; Richter, Dimitrios J; Τσάπας, Απόστολος; Tselepis, Alexandros D.; Tsioufis, Κonstantinos; Τζιόμαλος, Κωνσταντίνος; Tzotzas, Themistoklis; Vasiliadis, Themistoklis; Vlachopoulos, Charalambos; Mikhailidis, Dimitri P.; Mantzoros, Christos S.

doi:10.1016/j.metabol.2017.02.014

Cited by 213 publications

(147 citation statements)

References 97 publications

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“…Several factors could have contributed to this, including lack of awareness of treatment targets according to cardiovascular risk, lack of proper assessment of cardiovascular risk, and assumption by gastroenterologists and hepatologists that dyslipidemia would be managed by physicians attending to the patients' other coexisting metabolic conditions. 30 Despite our best effort, this study had several limitations. 22 A recent survey on patients, general practitioners, and cardiologists found that 19% to 27% of doctors were less confident in prescribing statins, as high as 73% of patients were fearful of the side effects of statins, and up to 10% of patients would decline a statin prescription when given.…”

Section: Discussionmentioning

confidence: 96%

Suboptimal treatment of dyslipidemia in patients with nonalcoholic fatty liver disease

Khoo

Wong

Goh

et al. 2019

J of Gastro and Hepatol

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Background and Aim Nonalcoholic fatty liver disease (NAFLD) patients often have dyslipidemia, and optimal treatment of dyslipidemia lowers the risk of cardiovascular disease and mortality. Our aim was to study the prescription of statin and low‐density lipoprotein cholesterol treatment targets in NAFLD patients. Methods Consecutive NAFLD patients attending five clinics in Asia were included in this study. The 10‐year cardiovascular disease risk was calculated based on the Framingham Heart Study, and patients were categorized as moderate, high, or very high risk for cardiovascular disease on the basis of the American Association of Clinical Endocrinologist 2017 Guidelines. The low‐density lipoprotein cholesterol treatment goal for each of the risk groups was 2.6, 2.6, and 1.8 mmol/L, respectively. Results The data for 428 patients were analyzed (mean age 54.4 ± 11.1 years, 52.1% male). Dyslipidemia was seen in 60.5% (259/428), but only 43.2% (185/428) were on a statin. The percentage of patients who were at moderate, high, and very high risk for cardiovascular disease was 36.7% (157/428), 27.3% (117/428), and 36.0% (154/428), respectively. Among patients who were on a statin, 58.9% (109/185) did not achieve the treatment target. Among patients who were not on a statin, 74.1% (180/243) should be receiving statin therapy. The percentage of patients who were not treated to target or who should be on statin was highest among patients at very high risk for cardiovascular disease at 79.6% (78/98) or 94.6% (53/56), respectively. Conclusion This study highlights the suboptimal treatment of dyslipidemia and calls for action to improve the treatment of dyslipidemia in NAFLD patients.

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Section: Discussionmentioning

confidence: 96%

Suboptimal treatment of dyslipidemia in patients with nonalcoholic fatty liver disease

Khoo

Wong

Goh

et al. 2019

J of Gastro and Hepatol

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“…anti-TNF for T2D) and using metabolic therapies for the treatment of inflammatory diseases (i.e. pioglitazone for NAFLD 254 , metformin for HIV lipodystrophy) with enormous potential. Better therapies are needed to prevent the epidemic of obesity from increasing metabolic and cardiovascular disease globally.…”

Section: Current Challenges and Future Directionsmentioning

confidence: 99%

Macrophage functions in lean and obese adipose tissue

2017

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Summary Interactions between macrophages and adipocytes influence both metabolism and inflammation. Obesity-induced changes to macrophages and adipocytes lead to chronic inflammation and insulin resistance. This paper reviews the various functions of macrophages in lean and obese adipose tissue and how obesity alters adipose tissue macrophage phenotypes. Metabolic disease and insulin resistance shift the balance between numerous pro- and anti-inflammatory regulators of macrophages and create a feed-forward loop of increasing inflammatory macrophage activation and worsening adipocyte dysfunction. This ultimately leads to adipose tissue fibrosis and diabetes. The molecular mechanisms underlying these processes have therapeutic implications for obesity, metabolic syndrome, and diabetes.

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“…These effects of statins may stem from increased eNOS activity by LSECs and from inhibition of Rho-kinase-mediated contractility of HSCs [92], which may shape the early phases of PHT. Further studies may determine whether some of the clinical benefits of statins related to cardiovascular and liver-related mortality in NAFLD [93,94] originate from a direct impact on sinusoidal homeostasis. Additional agents with impact on HSC activation and contractility include mitochondrial antioxidants [95,96], renin-angiotensin system inhibitors [97], and relaxin [98].…”

Section: Therapeutic Perspectivesmentioning

confidence: 99%