Abstract:

Metabolic-associated steatotic liver disease (MASLD) is a systemic metabolic
disorder closely associated with obesity, insulin resistance, and type 2 diabetes mellitus, and is
linked to a significantly increased cardiovascular risk. Although cardiovascular disease
represents the leading cause of mortality in this population, lipid abnormalities often remain
suboptimally managed. Statins are a cornerstone therapy for atherosclerotic risk reduction;
however, their use in patients with MASLD is frequently limited due to concerns regarding liver
safety. This review aims to summarize current evidence regarding the clinical indications for
statin therapy in patients with MASLD, their safety and efficacy, and their role in comprehensive
therapeutic management. Current international guideline recommendations, real-world
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prescribing patterns, and factors contributing to statin underutilization are discussed. Available
data demonstrate that statins are safe in patients with MASLD, including those with mildly
elevated liver enzymes, and can be effectively used to reduce cardiovascular risk. Nevertheless,
statins remain underutilized in clinical practice, highlighting the need for improved integration
of hepatology and cardiology care in this high-risk population.

Keywords: MASLD; statins; dyslipidemia; cardiovascular risk; clinical guidelines

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