Statins for MAFLD/MASH: another brick in the wall while waiting for final answers

I read with pleasure the paper by Zhou et al 1 analysing the long-term clinical outcomes and changes in liver elastography associated with statin usage in patients with metabolic-associated steatotic liver disease (MASLD). This is a population-based study of 7988 patients selected from a total of 17 849 MASLD patients seen in 16 centres in Europe, America and Asia and who had also transient elastography measurements of liver stiffness (LSM). The final cohort included patients >18 years that had at least two LSM, a controlled attenuation parameter denoting steatosis (over ≥248 dB/m), a prolonged follow-up (over 1 year, median 4.6 years), and no other cause of liver disease or excessive alcohol intake. Usage of statins was defined as the consistent use of statins on most days for more than 1 month within a year, which occurred in 3233 patients (40.4%). Patients were considered to have compensated advanced chronic liver disease (cACLD) if the first LSM was >10 kPa, which occurred in 17.2%. The primary outcome was a composite of all-cause death and liver-related events (LREs) (developing cirrhosis decompensation, hepatocellular carcinoma (HCC) or liver-related mortality). In addition, a secondary outcome was the change in LSM, categorised as progression, regression or stable based on observing or not changes in LSM of at least 20% or crossing the threshold of 10 kPa. The authors did Cox regression analysis for examining the association between statin …