A recent review has renewed attention on lipid-lowering therapies — especially statins and PCSK9 inhibitors — for managing Metabolic dysfunction–associated steatotic liver disease (MASLD), which affects an estimated one-quarter of the global population and carries both liver-related and cardiovascular risks.
The review underlines that statins remain the standard therapy for dyslipidaemia in MASLD. They are generally safe even in patients with compensated cirrhosis, and evidence indicates they may yield benefits beyond cholesterol control: improving liver fat accumulation, lowering risk of liver decompensation and liver cancer (hepatocellular carcinoma), and potentially improving survival.
However, statins should be used with caution in patients with decompensated cirrhosis — reserved only for those with strong cardiovascular need.
At the same time, PCSK9 inhibitors are gaining interest as a possible second-line option when statins alone don’t achieve adequate lipid control. Some small clinical studies suggest use of PCSK9 inhibitors in MASLD can lead to improvements in liver fat (steatosis) and certain biochemical markers.
But this evidence remains preliminary. Preclinical data, especially in cases of complete PCSK9 suppression (for example via RNA-based therapies), raise concerns about possible hepatic lipid accumulation, inflammation and fibrosis — meaning safety and long-term effects remain uncertain.
PCSK9 inhibitors for MASLD should currently be considered primarily for their cholesterol-lowering effects rather than as proven treatments for liver disease itself.
They call for larger, randomised clinical trials — ideally including liver-histology outcomes — to clarify whether PCSK9 therapies can be safely and effectively used for MASLD.
For now, lipid-management in MASLD should remain driven by cardiovascular risk, with statins as first-line therapy and PCSK9 inhibitors retained for selected cases when statins are insufficient.
