CONTEXT: Nonalcoholic fatty liver disease (NAFLD) has emerged as a public health issue, while no drugs have been specifically approved for treatment. OBJECTIVE: This study aimed to examine the association between statin use and NAFLD occurrence, progression, and regression. METHODS: A cohort study was designed based on the Kailuan Study and electronic medical records from the Kailuan General Hospital. Participants aged 18 years with statin indication, including statin and nonstatin users, were enrolled from 2010 to 2017. Propensity score (PS)-matched cohorts were also used. RESULTS: In the entire cohort, 21 229 non-NAFLD and 22 419 NAFLD patients (including 12 818 mild NAFLD patients) were included in the final analysis. After a median follow-up of about 4 years, the incidence of NAFLD occurrence and progression for statin users was lower than those for nonstatin users (occurrence: 84.7 vs 106.5/1000 person-years
progression: 60.7 vs 75.5/1000 person-years). Compared with nonstatin users, the risk of NAFLD occurrence (hazard ratio [HR]: 0.78
95% CI, 0.70-0.87) and regression (HR [95% CI]
0.71 [0.60-0.84]) was decreased in statin users. The significantly negative association was observed only in those with cumulative statin duration of 2 years or more (HR [95% CI] for occurrence 0.56 [0.46-0.69] vs 0.52 [0.30-0.90] for progression) and those with low or moderate atherosclerosis cardiovascular disease (ASCVD) risk (HR [95% CI] for occurrence 0.74 [0.66-0.82] vs 0.68 [0.57-0.80] for progression). No statistically significant correlation was observed between statin use, statin use duration, and NAFLD regression. The PS-matched cohort had similar results. CONCLUSION: Taking statin may decrease the risk of NAFLD occurrence and progression in the population with statin indication, suggesting the potential role of statin both in primary and secondary prevention strategies for NAFLD, especially among those with low or moderate ASCVD risk.