Statins and Fatty Liver: What Experts Say About the Best Options for Liver and Heart Health
Statins may actually help fatty liver and reduce heart health risks. Here’s what the research shows
No doubt about it: Statins lower artery-clogging cholesterol and cut risks of cardiovascular disease, heart attacks and strokes. But are the drugs helpful if you have fatty liver disease, or can they be harmful? We asked experts to cut through the confusion. Here’s what you need to know about the impact of statins on fatty liver.
The connection between high cholesterol and fatty liver
Fatty liver disease is characterized by a buildup of fat in the liver that’s known as hepatic steatosis. Left unchecked, fatty liver can lead to cirrhosis, liver scarring (fibrosis) and liver failure. And high cholesterol can contribute to the condition. That’s one reason the technical name for NAFLD (non-alcoholic fatty liver disease) was recently changed to MASLD (metabolic dysfunction-associated steatotic liver disease).
“The term ‘non-alcoholic’ was considered inaccurate because metabolic factors like obesity, high cholesterol and insulin resistance are key drivers of the condition,” explains Raj Dasgupta, MD, Chief Medical Advisor for Sleepopolis. Indeed, findings in the Journal of Translational Medicine suggest that harboring high cholesterol increases the risk of developing fatty liver over a six-year period by 46 percent. Plus, Mexican researchers point out that cholesterol elevations can worsen the progression of existing fatty liver. And of course, high cholesterol is a well-known risk factor for heart disease, which is the leading cause of death in people with MASLD.
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How statins can help if you have fatty liver
“Statins are actually recommended for many people with fatty liver because of the higher heart risk that comes with MASLD,” says Dr.Dasgupta. “We know from years of research that statins don’t just lower cholesterol, they also help reduce the risk of heart attacks and strokes.” In fact, researchers reporting in The Journal of Family Practice determined that taking statins lowered fatty liver patients’ odds of suffering strokes, heart attacks and other cardiovascular events by 68 percent.
What’s more, some research suggests that statins may be beneficial for fatty liver itself. A 2024 study in the journal Clinical Gastroenterology and Hepatology linked statin treatment to lower risks of fatty liver progression. And a report in the journal Clinical Nutrition concluded that the drugs reduced liver fat and improved liver function in fatty liver patients. “We think this could be because statins help reduce both cholesterol and inflammation in the liver,” notes Dr Dasgupta. “So while they’re not a direct treatment for MASLD, they might offer an extra layer of benefit.”
But do statins carry risks for people with fatty liver?
“A lot of people, including doctors, will tell me that statins are harmful for liver disease or cause damage to the liver. But that’s not really true,” says Mary Thomson, MD, MSc, assistant professor in the Division of Gastroenterology, Hepatology, and Nutrition at the University of Minnesota. Statins have been blamed for elevating liver enzymes, she notes.
In fact, the FDA once required their labels to recommend regular liver enzyme monitoring for people taking them. But the agency later lifted that requirement. As Dr. Thomson explains, elevations in liver enzymes can actually be caused by concerns such as diabetes and high cholesterol in people with MASLD. Rather than ruling out the drugs, this can make them especially helpful. “These people are at high risk of cardiovascular disease, so they can really benefit from statins,” she says.
“Serious liver injury from statins is rare,” agrees Dr. Dasgupta. “Routine liver monitoring during treatment isn’t considered necessary anymore unless there’s a reason to check.” How rare is rare? Experts at Drexel University and the University of North Carolina School of Medicine say the overall risk of statin-induced liver injury is about one in 100,000, while the risk of acute liver failure is about one in 1,000,000.
Your liver should be tested before taking statins
Liver function tests are still recommended before you begin statin treatment.
“If liver enzymes, things like ALT or AST, are more than three times the upper limit of normal and we don’t know why, we’ll usually hold off on starting a statin until we figure that out,” notes Dr. Dasgupta. “And if liver enzymes go up a little after starting a statin, they often come back down on their own even if the statin is continued. It’s pretty common, and most people don’t have any symptoms.”
But if you experience symptoms that could signal liver damage (like yellowing of the skin or eyes, dark urine, severe fatigue, or pain in the upper right abdomen), he advises seeing your doctor immediately.
How to manage fatty liver naturally
Consider the following smart tips:
Go for leafy greens
Replacing one daily serving of starchy carbohydrates (think: white bread, pasta and potatoes) with leafy green veggies such as kale and mustard greens can slow the progression of fatty liver disease, say Italian investigators. They found the strategy improved study participants’ FLI (fatty liver index, a marker of hepatic steatosis) within three months. Credit goes to the payload of polyphenols found in leafy greens, which combat processes like inflammation and oxidative stress that contribute to fatty liver.
Add omega-3s
Friendly fatty acids found in fish oil, omega-3s fight inflammation and oxidative stress while blunting fat production in the liver. That’s why a randomized controlled trial published in the journal Nutrients showed that taking 1000 mg of omega-3s three times daily reduced fibrosis in folks with fatty liver within six months.
Head out for a walk
Physical activity boosts the breakdown of fat (known as lipolysis) in the liver. And it doesn’t take taxing workouts to reap the benefits. In a JAMA Internal Medicine study, walking at a brisk pace for 30 minutes five times weekly for one year was as effective at cutting liver fat as exercising at a vigorous intensity for the same timeframe.
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