geoffrey modest medical blogs

  A recent article found that statins decreased liver fibrosis progression and lowered the risk of hepatocellular carcinoma and hepatic decompensation in patients with chronic liver disease (see   statin dec risk HCC if chr liver dz JAMAIntMed2025  in dropbox,, or doi:10.1001/jamainternmed.2025.0115)   Details : -- 16,501 participants were reviewed from the Research Patient Data Cape Registry, an aggregation of clinical data from 10 hospitals within the Mass General Brigham healthcare system in Boston, a database of roughly 4 million patients, with data from 2000 to 2023 on patients at least 40 years old with chronic liver disease (CLD) and a baseline Fibrosis-4 (FIB-4) score of 1.3 or higher    -- 6750 females (40.9%) and 9751 males (59.1%), including 3610 statin users (meaning being on statins for 180 days between their first CLD diagnosis and statin initiation) and 12,891 nonusers (no statin use for the 180-day period)         -- excl...

  There are a few new studies on non-alcoholic fatty liver disease (NAFLD) that challenge/illuminate some clinical issues in our conception of NAFLD and the approach to the disease.   The current blog is from a French study that found that “normal” ALT levels with a cutpoint of >40 IU/L were insufficient in diagnosing NAFLD (see  NAFLD NASH in DM with nl ALT DiabCare2023  in dropbox, or doi.org/10.2337/dc22-2048). The second (to follow soon) reviews the relatively common issue of NAFLD in “lean” individuals, who may well have a worse prognosis.   Details : -- 713 patients with diabetes and NAFLD documented by ultrasound who had been referred to a hepatologist for further workup by FIB-4 and VCTE (vibration-controlled transient elastography) -- all participants were asked to get a liver biopsy if their ALT levels were persistently >20 IU/L in females or >30 IU/L in males, and with no other evident cause of liver disease -- 63% male, BMI 32, waist ci...