Angiotensin‐converting enzyme inhibitors prevent liver‐related events in nonalcoholic fatty liver disease

• Published in: Hepatology (Baltimore, Md.) Vol. 76; no. 2; pp. 469 - 482
• Main Authors: Zhang, Xinrong, Wong, Grace Lai‐Hung, Yip, Terry Cheuk‐Fung, Tse, Yee‐Kit, Liang, Lilian Yan, Hui, Vicki Wing‐Ki, Lin, Huapeng, Li, Guan‐Lin, Lai, Jimmy Che‐To, Chan, Henry Lik‐Yuen, Wong, Vincent Wai‐Sun
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health, Inc 01.08.2022
• Subjects: Angiotensin; Animal models; Cirrhosis; Enzymes; Fatty liver; Hepatology; Kidney diseases; Liver cancer; Liver cirrhosis; Liver diseases; Patients
• ISSN: 0270-9139; 1527-3350; 1527-3350
• DOI: 10.1002/hep.32294

Background and Aims Angiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) can inhibit liver fibrogenesis in animal models. We aimed to evaluate the impact of ACEI/ARB use on the risk of liver cancer and cirrhosis complications in patients with NAFLD. Approach and Results We conducted a retrospective, territory‐wide cohort study of adult patients with NAFLD diagnosed between January 2000 and December 2014 to allow for at least 5 years of follow‐up. ACEI or ARB users were defined as patients who had received ACEI or ARB treatment for at least 6 months. The primary endpoint was liver‐related events (LREs), defined as a composite endpoint of liver cancer and cirrhosis complications. We analyzed data from 12,327 NAFLD patients (mean age, 54.2 ± 14.7 years; 6163 men [50.0%]); 6805 received ACEIs, and 2877 received ARBs. After propensity score weighting, ACEI treatment was associated with a lower risk of LREs (weighted subdistribution hazard ratio [SHR], 0.48; 95% CI, 0.35–0.66; p < 0.001), liver cancer (weighted SHR, 0.46; 95% CI, 0.28–0.75; p = 0.002), and cirrhosis complications (weighted SHR, 0.42; 95% CI, 0.27–0.66; p < 0.001), but ARB was not. In subgroup analysis, ACEI treatment was associated with greater reduction in LREs in patients with chronic kidney diseases (CKDs) than those without (CKD‐weighted SHR, 0.74; 95% CI, 0.52–0.96; p = 0.036; non‐CKD‐weighted SHR, 0.15; 95% CI, 0.07–0.33; p < 0.001). Conclusions ACEI, rather than ARB, treatment is associated with a lower risk of LREs in NAFLD patients, especially among those with CKD.