From the Research
For patients with hepatic steatosis, the target LDL cholesterol level should be below 100 mg/dL, with a more aggressive target of below 70 mg/dL for those with additional cardiovascular risk factors, as low LDL cholesterol is not an independent risk factor for hepatic steatosis. According to the most recent study 1, low LDL cholesterol was not a risk factor for hepatic steatosis compared to those with normal or high LDL. The study found that subjects with low LDL cholesterol exhibited a more favorable lipid profile but similar insulin resistance and hepatic fibrosis risk compared to other subjects with hepatic steatosis.
Key Considerations
- The distribution of variant alleles associated with NAFLD, including PNPLA3, GCKR, and MTTP, was indistinguishable between subjects with hepatic steatosis and low versus high LDL cholesterol 1.
- Statins are safe and beneficial in fatty liver disease, often improving liver function rather than worsening it, with atorvastatin (20-80 mg daily) or rosuvastatin (10-40 mg daily) being preferred options due to their potency and favorable hepatic safety profile.
- For patients who cannot tolerate statins or need additional LDL lowering, ezetimibe (10 mg daily) can be added.
- Treatment should be accompanied by lifestyle modifications including weight loss, reduced saturated fat intake, increased physical activity, and avoiding alcohol.
- Regular monitoring of lipid levels every 3-6 months and liver function tests initially and then annually is recommended.
LDL Target and Hepatic Steatosis
- The study 1 suggests that low serum LDL levels are not a useful predictor of hepatic steatosis and NAFLD.
- The findings of the study 1 are consistent with the idea that aggressive LDL management is important because patients with hepatic steatosis have increased cardiovascular risk, and treating dyslipidemia can help prevent both cardiovascular complications and progression of liver disease.
- Other studies, such as 2, 3, and 4, provide additional context on the importance of LDL management in patients with cardiovascular risk factors, but the most recent and highest quality study 1 provides the most relevant guidance for patients with hepatic steatosis.