Title:Can Serum Uric Acid Lowering Therapy Contribute to the Prevention or Treatment of Nonalcoholic Fatty Liver Disease?
Volume: 16
Issue: 3
Author(s): Paschalis Paschos, Vasilios G. Athyros, Achilleas Tsimperidis, Anastasia Katsoula, Nikolaos Grammatikos and Olga Giouleme*
Affiliation:
- Department of Internal Medicine, Gastroenterology and Hepatology Division of the Second Propedeutic, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki,Greece
Keywords:
Uric acid, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, allopurinol, atorvastatin, CVD.
Abstract: Nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disease in Western
countries with potential progression to nonalcoholic steatohepatitis (NASH) and cirrhosis, is associated
with cardiovascular disease (CVD) mortality. Several studies have reported a relationship between
uric acid and NAFLD/NASH and it seems that serum uric acid (SUA) is a significant independent factor
for the development of NAFLD. Potential mediating mechanisms include insulin resistance, endothelial
dysfunction, and activation of inflammasome, especially NLRP3. Moreover, emerging evidence indicates
a strong association between elevated SUA, metabolic syndrome (MetS), NAFLD, and CVD. The
emphasis of the present review is whether common therapy of elevated SUA levels and NAFLD can
improve compliance. There are several drugs with “off target” properties that show some separate benefit
on SUA reduction (e.g. losartan) or NAFLD/NASH (pioglitazone); however, there is no randomized
controlled trial (RCT) of a single drug with beneficial outcome for both diseases. Allopurinol reduces
SUA levels and ameliorates NAFLD/NASH; however, no RCTs have been performed up to now to
explore potential survival benefits. Atorvastatin, which has proven safe in NAFLD/NASH, reduces
SUA levels, ameliorates NAFLD/NASH, prevents liver fibrosis, and above all substantially reduces
CVD morbidity and mortality in comparison with those on statins but without NAFLD/NASH. This
drug could be a solution to improve compliance in both diseases, which are prevalent and becoming
even more common with the obesity, MetS, and type 2 diabetes mellitus epidemic.
