Statins are widely used for cardiovascular prevention, yet their hepatic benefits in older adults with steatotic liver disease (SLD) remain uncertain, particularly regarding liver-related events (LREs) and the modifying role of cardiometabolic risk factors (CMRFs). This retrospective cohort study used data from the Korean National Health Insurance Service-Senior cohort, comprising 125,926 adults aged ≥ 60 years with fatty liver index ≥ 30, followed from 2011 to 2019. Participants with prior liver disease or LREs at baseline were excluded. Cumulative statin exposure quantified as cumulative defined daily dose (cDDD) and categorized as non-use, 1 cDDD to 89 cDDD, 90 cDDD to 364 cDDD, and ≥ 365 cDDD; statin intensity classified as low, moderate, or high. The primary outcomes were incident LREs (primary liver cancer, liver cirrhosis, and decompensated cirrhosis) identified using validated ICD-10 codes. Associations were assessed using Fine and Gray competing-risk models and expressed as subdistribution hazard ratios (SHRs). During a median follow-up of 9 years, 3,445 LREs occurred over 1,054,343 person-years. Statin use was associated with a dose-dependent reduction in LRE risk. Compared with non-users, participants with ≥ 365 cDDD had the lowest risk of total LREs (SHR, 0.69; 95% CI, 0.61–0.78), primary liver cancer (SHR, 0.63; 95% CI, 0.52–0.76), and liver cirrhosis (SHR, 0.66; 95% CI, 0.57–0.77). Moderate- to high-intensity statin conferred greater protection than low-intensity statin. Statin therapy was associated with a significant and dose-dependent reduction in the risk of LREs among older adults with SLD, including those aged ≥ 75 years.
Kang et al. (Sun,) studied this question.