Friday, January 28, 2011

Atorvastatin and Antioxidants for the Treatment of Nonalcoholic Fatty Liver Disease

Subject Category: Liver
Am J Gastroenterol 2011; 106:71–77; doi:10.1038/ajg.2010.299; published online 14 September 2010

Atorvastatin and Antioxidants for the Treatment of Nonalcoholic Fatty Liver Disease: The St Francis Heart Study Randomized Clinical Trial

Temitope Foster MD, MSCR1, Matthew J Budoff MD2, Sammy Saab MD, MPH, AGAF1, Naser Ahmadi MD2, Craig Gordon BS3 and Alan D Guerci MD3
1Department of Medicine, University of California, Los Angeles, California, USA
2Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
3Department of Research, St Francis Hospital, Roslyn, New York, USA
Correspondence: Temitope Foster, MD, MSCR, Department of Medicine, University of California, 10833 Le Conte Avenue Room 44-138, Los Angeles, California 90095, USA. E-mail:

Received 5 January 2010; Accepted 7 May 2010; Published online 14 September 2010.

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Nonalcoholic fatty liver disease (NAFLD) is defined as the spectrum of benign fatty liver to necroinflammation and fibrosis. Its prevalence has been found to be as high as 39%. It is estimated that up to 15% of those affected will go on to have progressive liver disease. Currently, there is no proven therapy for NAFLD. In this study, we aim to determine whether statin therapy may be an effective treatment for NAFLD and identify independent predictors of NAFLD.

In all, 1,005 men and women, aged 50–70 years were randomized to receive either a daily combination of atorvastatin 20 mg, vitamin C 1 g, and vitamin E 1,000 IU vs. matching placebo, as part of the St Francis Heart Study randomized clinical trial. Liver to spleen (LS) ratios were calculated on 455 subjects with available computed tomography scans performed at baseline and follow-up to determine NAFLD prevalence. Baseline and final LS ratios were compared within treatment groups, and results were compared between the treatment and placebo groups using univariate and multivariate analyses. Mean duration of follow-up was 3.6 years.

RESULTS: There were 80 patients with NAFLD at baseline. We identified baseline triglyceride levels (odds ratio (OR)=1.003, P<0.001) and body mass index (OR=0.10, P<0.001) as independent correlates of NAFLD. Treatment with atorvastatin combined with vitamins E and C significantly reduced the odds of NAFLD at the end of follow-up, 70 vs. 34% (OR=0.29, P<0.001).

CONCLUSIONS: In conclusion, atorvastatin 20 mg combined with vitamins C and E is effective in reducing the odds of having hepatic steatosis by 71% in healthy individuals with NAFLD at baseline after 4 years of active therapy.

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