Efficacy and safety of statins for nonalcoholic/metabolic dysfunction-associated fatty liver diseases: a systematic review and meta-analysis

Introduction Nonalcoholic fatty liver diseases (NAFLD) and metabolic dysfunction-associated fatty liver diseases (MAFLD) are closely associated with metabolic syndrome, including obesity, dyslipidemia, and insulin resistance (IR). Thus, stains may be considered for the management of NAFLD/MAFLD. However, its efficacy and safety remain unclear in NAFLD/MAFLD.Methods The PubMed, EMBASE, and Cochrane library databases were searched to identify randomized controlled trials (RCTs) evaluating the efficacy and/or safety of statins in NAFLD/MAFLD. Risk ratios (RRs) and weight mean differences (WMDs) with their 95% confidence intervals (CIs) were calculated.Results Seven studies involving 993 patients with NAFLD/MAFLD were included. Statins were significantly associated with reductions in alanine aminotransferase (ALT, WMD = −9.76 U/L, 95%CI: −17.28, −2.24, p = 0.010), aspartate aminotransferase (AST, WMD = −4.46 U/L, 95%CI: −9.03, 0.11, p = 0.060), gamma-glutamyl-transpeptidase (GGT, WMD = −10.18 U/L, 95%CI: −13.65, −6.70, p < 0.001), low-density lipoprotein (LDL, WMD = −0.86 mmol/L, 95%CI: −1.06, −0.66, p < 0.001), total cholesterol (TC, WMD = −0.88 mmol/L, 95%CI: −1.14, −0.61, p < 0.001), and triglyceride (TG, WMD = −0.32 mmol/L, 95%CI: −0.45, −0.19, p < 0.001) levels. Additionally, statins did not increase the risk of myalgia (RR = 0.96, 95%CI: 0.10, 9.00, p = 0.970).Conclusions Statins could improve liver function and lipid profiles in NAFLD/MAFLD. No myalgia was reported as AEs in the studies we included and the overall safety was favorable.Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42025630809.