Underuse of statins in MASLD despite population-based associations with lower liver stiffness

BACKGROUND & AIMS: Statins, used for cardiovascular disease (CVD) prevention, may offer hepatoprotective benefits. However, adherence to treatment indications and the associations between statin use, metabolic dysfunction-associated steatotic liver disease (MASLD), and elevated liver stiffness in the general population remain poorly understood. METHODS: This prospective, population-based study included adults aged ≥40 years between 2011 and 2020. We evaluated statin indications for CVD risk using prevailing European Society of Cardiology/European Atherosclerosis Society clinical practice guidelines based on SCORE2 and SCORE2-Older Persons algorithms. We used multivariable regression to examine associations between statins, MASLD, and elevated liver stiffness, adjusting for demographic, socioeconomic and metabolic covariables. We performed dose-response analyses using WHO defined daily dosages. RESULTS: Of 6,405 eligible individuals, 6,055 participants were included in the analysis (median age 64 years; 56% female); MASLD was present in 32%, elevated liver stiffness in 4.8%, and statin use in 21%. Participants with MASLD had higher predicted 10-year CVD risk compared to participants without MASLD (p