Statins and non-alcoholic fatty liver disease: A concise review

Non-alcoholic fatty liver disease (NAFLD) is a common hepatic manifestation of metabolic syndrome affecting 20–30 % of the adult population worldwide. This disease, which includes simple steatosis and non-alcoholic steatohepatitis, poses a significant risk for cardiovascular and metabolic diseases. Lifestyle modifications are crucial in the treatment of NAFLD; however, patient adherence remains challenging. As there is no specific treatment, drug repositioning is being researched as an alternative strategy. Statins, which are known for their cholesterol-lowering effects, are considered potential interventions for NAFLD. This review aimed to present the current understanding of the effects of statins on liver physiology in the context of NAFLD. The pathophysiology of NAFLD includes steatosis, inflammation, and fibrosis, which are exacerbated by dyslipidemia and insulin resistance. Statins, which inhibit 3-hydroxy-3-methylglutaryl-CoA reductase, have pleiotropic effects beyond cholesterol-lowering and affect pathways related to inflammation, fibrogenesis, oxidative stress, and microcirculation. Although clinical guidelines support the use of statins for dyslipidemia in patients with NAFLD, more studies are needed to demonstrate their efficacy in liver disease. This comprehensive review serves as a foundation for future studies on the therapeutic potential of statins in NAFLD. [Display omitted] •Cholesterol exacerbates the progression of NAFLD through mechanisms such as lipotoxicity, disruption of the gut-liver axis and microvascular dysfunction, emphasizing the importance of cholesterol in NAFLD pathogenesis.•Statins show beneficial effects beyond lipid lowering by improving fibrosis, inflammation, oxidative stress and microcirculation in NAFLD/NASH. These effects include restoring endothelial function, reducing proinflammatory cytokines and increasing nitric oxide production.•Statins improve liver microvascular dysfunction in NAFLD by decreasing leukocyte recruitment, reducing stellate cell activation, and restoring microvascular perfusion, thereby attenuating disease progression.•Although statins show promise in reducing the cardiovascular risks and liver inflammation associated with NAFLD, the evidence for their direct effects on liver disease is not yet conclusive, so further large-scale, well-designed studies are needed.•Although statins are generally safe, they can cause mild muscle-related symptoms and transient elevations in liver enzymes. Their use