Statin use association with all-cause mortality and liver-related outcomes: are the benefits true?

Zhou and colleagues published an observational study on the beneficial effects of statin use in steatotic liver disease.1 Using a large, multicentre database, the author reported that statin use in patients with metabolic-associated steatotic liver disease (MASLD) at 3-year median follow-up was associated with substantially lower risk of all-cause mortality (HR: 0.23, 95% CI 0.13 to 0.43), liver-related events (LRE) (HR: 0.38, 95% CI 0.27 to 0.54) and incidence of liver stiffness progression (HR: 0.41, 95% CI 0.33 to 0.51). These benefits were reportedly seen with all types of statins. However, statin use was not associated with incidence of liver fibrosis regression or 20% decrease in liver stiffness measurement. The authors adjusted for possible confounders, follow-up was a reasonable period of time and the variables were clearly defined. We are intrigued by these results and have the following comments.