title: Under-prescription of statins in patients with non-alcoholic fatty liver disease.
abstract: Non-alcoholic fatty liver disease (NAFLD) is a common disease associated with high cardiovascular risk. Management of dyslipidaemia plays a pivotal role in the prevention of CV events and statins have proved to be safe in these patients. However, in everyday clinical practice statin prescription is sometimes limited because of the concern of physicians about side-effects. The aim of the study was to investigate if the presence of NAFLD affects the prescription of lipid-lowering treatment in a large series of patients with cardio-metabolic disorders.
  
  
  
  Cardiovascular risk and LDL-C targets were defined according to ESC/EAS Guidelines in 605 consecutive adult subjects referred for screening of suspected metabolic diseases. Liver steatosis was assessed by ultrasound Hamaguchi criteria. In the whole cohort, 442 patients had indication for cholesterol-lowering treatment. Lack of statin prescription was present in 230 (52.0%) patients. Of these, 77 (33.5%) were very high-risk, 48 (20.8%) high-risk, and 105 (45.6%) moderate risk patients. Only 44% of the NAFLD patients with indication for statin treatment were on therapy. NAFLD patients on statin treatment had significantly lower ALT values as compared to those not on treatment (p < 0.05).
  
  
  
  Our findings show that about 50% of patients with indication to statin treatment do not receive any cholesterol-lowering medication. Statin under-use was particularly high in subjects with NAFLD. Use of statin treatment should be encouraged in the context of NAFLD, as it may improve lipid profile and reduce the cardiovascular risk in this setting.
authors.affiliation: Department of Internal Medicine and Medical Specialties - Sapienza University, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Del Ben
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences - Sapienza University, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Baratta
authors.affiliation: Department of Internal Medicine and Medical Specialties - Sapienza University, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Polimeni
authors.affiliation: Department of Internal Medicine and Medical Specialties - Sapienza University, Rome, Italy; Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences - Sapienza University, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Pastori
authors.affiliation: Department of Internal Medicine and Medical Specialties - Sapienza University, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Loffredo
authors.affiliation: Department of Internal Medicine and Medical Specialties - DIBIMIS, School of Medicine, University of Palermo, Palermo, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Averna
authors.affiliation: Department of Internal Medicine and Medical Specialties - Sapienza University, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Violi
authors.affiliation: Department of Public Health and Infectious Diseases - Sapienza University, Rome, Italy. Electronic address: francesco.angelico@uniroma1.it.
authors.forename: F
authors.initials: F
authors.lastname: Angelico
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D019983:Guideline Adherence; D006300:Health Services Misuse; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular risk; Non-alcoholic fatty liver disease; Statins; Under-prescription