Statins Are Underutilized in Patients with Nonalcoholic Fatty Liver Disease and Dyslipidemia

Cardiovascular disease provides the greatest mortality risk in patients with nonalcoholic fatty liver disease (NAFLD). Clinical practice guidelines recommend statins to treat dyslipidemia in patients with NAFLD; however, the extent to which such patients receive statins has not been studied. We conducted a structured medical record review to assess for appropriate statin use in patients in a Veterans Administration facility with dyslipidemia and NAFLD as well as a parallel cohort without NAFLD. Appropriate statin use was defined as receipt of statins without a clinically significant, unjustified dose change during the study period. Of 255 patients with NAFLD and dyslipidemia, 152 (59.6 %) patients received appropriate statin care. Primary care providers (PCPs) recognized the presence of NAFLD in 106 patients (41.6 %). Among the 63 of 106 (59.4 %) patients who were on a statin at the time of detection, 24 (38.1 %) received a clinically significant dose reduction or discontinuation. Patients whose PCPs recognized the presence of NAFLD (adjusted OR = 0.34, 95 % CI = 0.18-0.64) were less likely to receive appropriate statin care than patients with undetected NAFLD. Also, patients with detected NAFLD were less likely than dyslipidemic patients without NAFLD to receive appropriate statin care (OR = 0.45, 95 % CI = 0.25-0.79). Statins are underused in patients with NAFLD and dyslipidemia. The most important determinant for inappropriate statin use was PCP recognition of NAFLD. While these results need to be confirmed in non-VA healthcare systems, they highlight the need for efforts to enhance PCP knowledge of existing guidelines regarding statin use in NAFLD.