Via practica 6/2010

Hypolipidemic treatment of patients with nonalcoholic fatty liver disease

Introduction. In most patients with nonalcoholic fatty liver disease exist a wide variety of lipid metabolism disorder, most notably hypertriacylglycerolemia. Among drugs most commonly used to treat these disorders are fibrates, statins, combination of the two, or combination of statin and ezetimib. Goal of this treatment is to correct the metabolic disorder, lower the accumulation of fat in hepatocytes and stop the progression of fibrogenesis. Administration of fibrates lowers the serum activity of liver tests, but has little effect on fibrogenesis. Statins are able to lower the activity of liver tests, but also able to stop the progression of fibrogenesis. Addition of ezetimib to statin therapy has no additional benefit. Adverse effects of hypolipidemic treatment are rare, but all published studies have the drawback of small size and short duration of treatment. Aim. To find out if hypolipidemic treatment has any effect on liver tests activity and lipoprotein metabolism in patients with nonalcoholic fatty liver disease. Patients and methods. We enrolled 90 patients (56 female, 34 male) with average age 50,25±10,05 years. 25 patients were treated with atorvastatin (20mg daily), 16 patients were treated with fenofibrate (200 or 267 mg daily) and 19 patients were treated with simvastatin (20 mg daily). 30 patients were treated with combination of statin and fibrate. Biochemical activity of liver tests and parameters of lipoprotein metabolism were evaluated after 3 and 6 months. Results. Hypolipidemic treatment in all groups resulted not only in improvement of lipoprotein metabolism, but also in lowering the activity of liver transaminases and GGT. No serious adverse effects were observed. Conclusion. Patients with nonalcoholic fatty liver disease are legitimate candidates for hypolipidemic treatment. Drugs used in this indication are clinically effective and safe.

Keywords: nonalcoholic fatty liver disease, lipid metabolism disorder, treatment, statins, fibrates