Metabolism - Clinical and Experimental The use of statins alone, or in combination with pioglitazone and other drugs, for the treatment of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis and related cardiovascular risk. An Expert Panel Statement  Vasilios G. Athyros, Theodore K. Alexandrides, Helen Bilianou, Evangelos Cholongitas, Michael Doumas, Emmanuel S. Ganotakis, John Goudevenos, Moses S. Elisaf, Georgios Germanidis, Olga Giouleme, Asterios Karagiannis, Charalambos Karvounis, Niki Katsiki, Vasilios Kotsis, Jannis Kountouras, Evangelos Liberopoulos, Christos Pitsavos, Stergios Polyzos, Loukianos S. Rallidis, Dimitrios Richter, Apostolos G. Tsapas, Alexandros D. Tselepis, Konstantinos Tsioufis, Konstantinos Tziomalos, Themistoklis Tzotzas, Themistoklis G. Vasiliadis, Charalambos Vlachopoulos, Dimitri P. Mikhailidis, Christos Mantzoros  Metabolism - Clinical and Experimental  Volume 71, Pages 17-32 (June 2017) DOI: 10.1016/j.metabol.2017.02.014 Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 1 Histological characteristics of non-alcoholic steatohepatitis (NASH): hepatocyte ballooning, diffuse lobular acute and chronic inflammation, and perivenular as well as perisinusoidal collagen disposition compared with normal liver structure (own data). Metabolism - Clinical and Experimental 2017 71, 17-32DOI: (10.1016/j.metabol.2017.02.014) Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 2 Epidemiology of, NAFLD, NASH, cirrhosis and hepatocellular carcinoma. Based on Refs. [1–5, 13]. NAFLD = non-alcoholic fatty liver disease, NASH = non-alcoholic steatohepatitis, HCC=hepatocellular carcinoma. Metabolism - Clinical and Experimental 2017 71, 17-32DOI: (10.1016/j.metabol.2017.02.014) Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 3 The clinical outcome of NASH. Based on data from Refs. [2, 5, 10, 11]. NASH = non-alcoholic steatohepatitis, HCC=hepatocellular carcinoma. Metabolism - Clinical and Experimental 2017 71, 17-32DOI: (10.1016/j.metabol.2017.02.014) Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 4 (a) Algorithm for the diagnosis of NAFLD/NASH with elevated aminotransferases activity; data from www.massgeneral.org/fattyliver. NAFLD = non-alcoholic fatty liver disease, NASH = non-alcoholic steatohepatitis, HCC=hepatocellular carcinoma, APRI = AST to Platelet Ratio Index, BMI=body mass index, ALT = alanine transaminase, AST=aspartate transaminase, FLI=fatty liver index, MetS = metabolic syndrome, T2DM=type 2 diabetes mellitus, NFS=NAFLD fibrosis score, FIB-4=fibrosis 4 calculator, APRI = AST to Platelet Ratio Index. ( b) Algorithm for the diagnosis of NAFLD/NASH with normal transaminases; data from www.massgeneral.org/fattyliver. NAFLD = non-alcoholic fatty liver disease, NASH = non-alcoholic steatohepatitis, MetS = metabolic syndrome, HCV=hepatitis C virus. Metabolism - Clinical and Experimental 2017 71, 17-32DOI: (10.1016/j.metabol.2017.02.014) Copyright © 2017 Elsevier Inc. Terms and Conditions

Fig. 5 Pragmatic therapeutic algorithm including pioglitazone, statin and ezetimibe treatment for NAFLD or NASH patients with dyslipidemia (from our own data). NAFLD = non-alcoholic fatty liver disease, NASH = non-alcoholic steatohepatitis, the most advanced form of NAFLD characterized by liver inflammation, ALT = alanine transaminase, AST=aspartate transaminase, CK=creatine kinase. Metabolism - Clinical and Experimental 2017 71, 17-32DOI: (10.1016/j.metabol.2017.02.014) Copyright © 2017 Elsevier Inc. Terms and Conditions