ACE inhibitors prevent liver‐related events in non‐alcoholic fatty liver disease

Background & 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 hepatocellular carcinoma (HCC) and cirrhotic complications in patients with non-alcoholic fatty liver disease (NAFLD).

Approach & 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 at least six months. Primary endpoint was liver-related events, defined as a composite endpoint of HCC and cirrhotic complications. We analyzed data from 12,327 NAFLD patients (mean age 54.2 ± 14.7 years; 6,163 men [50.0%]); 6,805 received ACEI and 2,877 received ARB. After propensity score weighting, ACEI treatment was associated with a lower risk of liver-related events (weighted subdistribution hazard ratio (SHR) 0.48, 95% confidence interval (CI) 0.35-0.66, P <0.001), HCC (weighted SHR 0.46, 95% CI 0.28-0.75, P =0.002), and cirrhotic 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 liver-related events in patients with chronic kidney diseases (CKD) 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 liver-related events in NAFLD patients, especially among those with CKD.

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