Liver and Bile
Hepatology. 2022;76(2):469–82
Angiotensin-converting enzyme inhibitors prevent liver-related events in non-alcoholic fatty liver disease
Background and aims: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) can inhibit liver fibrogenesis in animal models. The authors aimed to evaluate the impact of ACEI/ARB use on the risk of liver cancer and cirrhosis complications in patients with non-alcoholic fatty liver disease (NAFLD).
Approach and results: They 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 end point was liver-related events (LREs), defined as a composite end point of liver cancer and cirrhosis complications. Data from 12,327 NAFLD patients (mean age, 54.2 ± 14.7 years; 6163 men [50%]) were analyzed; 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% confidence interval [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: Angiotensin-converting enzyme inhibitor, rather than angiotensin receptor blocker, treatment is associated with a lower risk of liver-related events in non-alcoholic fatty liver disease patients, especially among those with chronic kidney disease.
DOI: 10.1002/hep.32294