We read with great interest the review by Moscatiello et al. Citation[1] on the importance of targeting all components of the metabolic syndrome (MetS) in the treatment of non-alcoholic fatty liver disease (NAFLD). A few comments may be of interest.
One of the hallmarks of MetS is the presence of too many definitions; the joint interim statement of several major organisations published in 2009 Citation[2] attempts to overcome this issue. In this context, the selection of diagnostic criteria may influence the prevalence of MetS Citation[3].
Apart from other cardiovascular risk factors, possible links between NAFLD and elevated serum uric acid (SUA) levels Citation[4] or chronic kidney disease Citation[5] have been recently proposed. Based on this concept, SUA and renal function should be monitored in NAFLD patients.
The clinical significance of statin use in the treatment of both NAFLD and MetS has been reported Citation[6,7]. Recently, in a post hoc analysis of the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) study Citation[8,] statin treatment was associated with significantly less vascular events in patients with coronary heart disease (CHD) and NAFLD (68% relative risk reduction) compared with those with CHD but no NAFLD (39% relative risk reduction; p < 0.007). Furthermore, in the majority of patients with abnormal liver function tests (LFTs) (i.e., < 3 times the upper limit of normal) at baseline, statins improved LFTs, whereas these biomarkers were worsened in those patients not receiving statins Citation[8]. These beneficial effects of statins on liver biomarkers, along with previously reported favourable changes in renal function Citation[9], support their use in NAFLD treatment.
Declaration of interest
The authors state no conflict of interest and have received no payment in preparation of this manuscript.
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- Athyros VG, Mikhailidis DP, Liberopoulos EN, Effect of statin treatment on renal function and serum uric acid levels and their relation to vascular events in patients with coronary heart disease and metabolic syndrome: a subgroup analysis of the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) Study. Nephrol Dial Transplant 2007;22:118-27