DAY 2: Resmetirom Improved Key Cardiovascular Risk Markers Regardless of Statin Use

A secondary analysis of data from the phase 3 MAESTRO-NASH trial showed that treatment with resmetirom led to significant improvements in atherogenic lipid profiles in people with metabolic dysfunction–associated steatohepatitis (MASH) and moderate-to-advanced fibrosis, irrespective of background statin therapy.

Patients with MASH have a 1.5-fold to 2.5-fold increased risk of cardiovascular disease, driven by the combined effects of atherogenic dyslipidemia, chronic systemic inflammation, and insulin resistance [Li S et al. Curr Hypertens Rep 2026;28:33]. Participants in the ongoing phase 3 MAESTRO-NASH trial who received daily resmetirom (80 mg or 100 mg) over 1 year experienced significant improvements in liver fibrosis, as well as reductions in low-density lipoprotein cholesterol (LDL-C) levels by week 24. The initial findings suggested that resmetirom may confer cardioprotective benefits beyond its primary effects reflected in the histologic improvement of MASH. 

The secondary analysis presented at the 2026 Annual Scientific Meeting of the American College of Gastroenterology in Nashville, Tennessee showed that resmetirom 100 mg daily improved lipid profiles, including the levels of LDL-C, Apolipoprotein B (ApoB), and Lipoprotein(a), regardless of whether patients were taking statins at baseline.  
The analysis included participants with mild, moderate, and advanced fibrosis at baseline (stages F1B through F3) who were randomly assigned to receive either placebo or resmetirom in a daily dose of 80 mg or 100 mg. Nearly half of the 966 participants (49%) were taking statins at baseline, with 27% of those receiving high-intensity statin therapy. The therapies were generally well tolerated, with no reports of statin- or resmetirom-related adverse events. 

At week 24, placebo-corrected reductions were observed for all lipids and lipoproteins across both statin and non-statin subgroups. In the group of statin-treated patients who received resmetirom 100 mg daily, 44% of individuals with baseline LDL-C levels of 70 mg/dL or greater achieved LDL-C levels below 70 mg/dL. Among participants with elevated Lp(a) levels who received the 100 mg resmetirom dose, 36% of those with baseline Lp(a) of 30 mg/dL or greater and 38% of those with baseline Lp(a) of 50 mg/dL or greater saw Lp(a) levels fall below those thresholds. Moreover, patients with the highest cardiovascular risk based on their baseline Lp(a) levels achieved significant reductions in Lp(a) levels with resmetirom, regardless of statin use. 

“Resmetirom demonstrated consistent efficacy across key MASH endpoints and reduced multiple atherogenic lipids and lipoproteins, regardless of baseline statin use, supporting concomitant use of resmetirom and statins in patients with both hepatic and cardiometabolic risk factors,” said author Rebecca Taub, MD, who presented the results in a poster session. Taub and colleagues noted that, based on these findings, resmetirom may provide additional cardiometabolic benefit for patients with MASH and could be used as an additive therapy in those who are taking statins, which have no meaningful effect on lipoproteins such as Lp(a).