Risk of cardiovascular disease in elderly subjects with obesity and liver fibrosis and the potential benefit of statin treatment

• Published in: European journal of clinical investigation Vol. 55; no. 3; pp. e14368 - n/a
• Main Authors: Theel, Willy B., Jong, Vivian D., Castro Cabezas, Manuel, Grobbee, Diederick E., Jukema, Johan W., Trompet, Stella
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.03.2025; John Wiley and Sons Inc
• Subjects: Aged; Aged, 80 and over; Atrial Fibrillation - epidemiology; Body Mass Index; Body weight; cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Female; Fibrosis; FIB‐4 index; Hazard assessment; Health risks; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Liver; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - epidemiology; Liver diseases; liver fibrosis; Male; Mortality; Myocardial Infarction - epidemiology; Obesity; Obesity - complications; Obesity - epidemiology; Older people; Original; Overweight - epidemiology; Placebos; Population studies; Pravastatin; Pravastatin - therapeutic use; Proportional Hazards Models; Prospective Studies; Risk factors; statin; Statins; Statistical models; Stroke - epidemiology; cardiovascular disease; FIB‐4 index; liver fibrosis; statin; obesity
• ISSN: 0014-2972; 1365-2362; 1365-2362
• DOI: 10.1111/eci.14368

Background Liver fibrosis progression is influenced by older age and cardiometabolic risk factors such as obesity and is associated with an increased risk of cardiovascular events. While statins may protect against cardiovascular complications, their effects in elderly individuals with obesity and liver fibrosis are unclear. Method The PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) database was used to evaluate the effect of pravastatin on major adverse cardiovascular events in an elderly population (>70 years). Subjects were categorized by BMI: lean (<25 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2). Liver fibrosis was assessed using the FIB‐4 index: low risk (<2.0), intermediate risk (2.0–2.66) and high risk (≥2.67). Time‐to‐event data were analysed using the Cox proportional hazards model, adjusted for confounders and compared the placebo and pravastatin groups. Results A total of 5.804 subjects were included. In the placebo group, the highest risk group (high FIB‐4 and obesity) had a significantly higher hazard ratio for (non‐)fatal stroke (HR 2.74; 95% CI 1.19–6.29) compared to the low FIB‐4, lean BMI group. This risk disappeared in the same pravastatin group. Pravastatin did not affect other cardiovascular endpoints. All‐cause mortality was significantly higher in subjects with lean weight and high FIB‐4 on placebo (HR 1.88; 95% CI 1.14–3.11), but not on pravastatin (HR .58; 95% CI .28–1.20). Conclusion Elderly individuals with obesity and liver fibrosis are at higher risk for (non‐)fatal stroke, which is reduced with pravastatin. Pravastatin also potentially lowers all‐cause mortality in subjects with lean weight and liver fibrosis. MASLD affects over 80%–90% of people with obesity, causing severe health risks. Elderly individuals with obesity and liver fibrosis are at increased risk of stroke. Pravastatin reduces the risk of (non‐)fatal stroke in these high‐risk individuals. Statin lower all‐cause mortality in elderly with a healthy weight and liver fibrosis.