Is there a role of lipid-lowering therapies in the management of fatty liver disease?  

作　　者：Ismini Tzanaki Aris P Agouridis Michael S Kostapanos 

机构地区：[1]School of Medicine,European University Cyprus,Nicosia,Cyprus,Nicosia 2404,Cyprus [2]School of Medicine,European University Cyprus,Nicosia 2404,Cyprus [3]General Medicine,Addenbrooke's Hospital,Cambridge University Hospitals,Cambridge CB20QQ,United Kingdom

出　　处：《World Journal of Hepatology》2022年第1期119-139,共21页世界肝病学杂志（英文版）（电子版）

摘　　要：Atherogenic dyslipidemia is characterized by increased triglyceride-rich lipoproteins and low high-density lipoprotein cholesterol concentrations.It is highly prevalent in non-alcoholic fatty liver disease(NAFLD)and contributes to the increased cardiovascular risk associated with this condition.Alongside insulin resistance it plays an important pathogenetic role in NAFLD/non-alcoholic steatohepatitis(NASH)development and progression.It has been shown that cholesterol-lowering reduces cardiovascular risk more in NAFLD vs non-NAFLD high-risk individuals.This evidence highlights the importance of effective lipid modulation in NAFLD.In this narrative review the effects of the most commonly used lipid-lowering therapies on liver outcomes alongside their therapeutic implications in NAFLD/NASH are critically discussed.Preclinical and clinical evidence suggests that statins reduce hepatic steatosis,inflammation and fibrosis in patients with NAFLD/NASH.Most data are derived from observational and small prospective clinical studies using changes in liver enzyme activities,steatosis/fibrosis scores,and imaging evidence of steatosis as surrogates.Also,relevant histologic benefits were noted in small biopsy studies.Atorvastatin and rosuvastatin showed greater benefits,whereas data for other statins are scarce and sometimes conflicting.Similar studies to those of statins showed efficacy of ezetimibe against hepatic steatosis.However,no significant anti-inflammatory and anti-fibrotic actions of ezetimibe have been shown.Preclinical studies showed that fibrates through peroxisome proliferator-activated receptor(PPAR)αactivation may have a role in NAFLD prevention and management.Nevertheless,no relevant benefits have been noted in human studies.Species-related differences in PPARαexpression and its activation responsiveness may help explain this discrepancy.Omega-3 fatty acids reduced hepatic steatosis in numerous heterogeneous studies,but their benefits on hepatic inflammation and fibrosis have not been established.Promising p

关 键 词：Non-alcoholic fatty liver Non-alcoholic steatohepatitis STATIN EZETIMIBE FIBRATES ω-3 fatty acids Bile acid resins 

分 类 号：R575.5[医药卫生—消化系统]