https://pubmed.ncbi.nlm.nih.gov/33871081/ NAFLD

J Gastroenterol Hepatol. 2021 Apr 19.
doi: 10.1111/jgh.15523. Online ahead of print.

Interplay between non-alcoholic fatty liver disease and cardiovascular risk in an asymptomatic general population

Grazia Pennisi 1, Vito Di Marco 1, Carola Buscemi 1, Giovanni Mazzola 2, Cristiana Randazzo 3, Federica Spatola 1, Antonio Craxì 1, Silvio Buscemi 3, Salvatore Petta 1

Abstract

Background and aims: Nonalcoholic fatty liver (NAFLD) is a major cause of liver disease worldwide leading also to a higher risk of cardiovascular events. We aimed to evaluate the impact of fatty liver and fibrosis on cardiovascular risk in a general population.

Methods: 542 subjects included in the community-based ABCD (Alimentazione, Benessere Cardiovascolare e Diabete) study were recruited. Steatosis (CAP > 288 dB/m) and severe fibrosis (Low risk, LSM < 7.9 KPa with M probe and < 5.7 KPa with XL probe; intermediate risk, LSM 7.9-9.5 KPa with M probe and 5.7-9.2 KPa with XL probe; high risk, LSM ≥9.6 KPa with M probe and ≥9.3 KPa with XL probe) were assessed with FibroScan. Cardiovascular risk was evaluated by the Atherosclerotic Cardiovascular Disease (ASCVD) risk estimator and defined low if < 5%, borderline if 5%-7.4%, intermediate if 7.5%-19.9% and high if ≥20%. Intima-media thickness (IMT) was measured with ultrasound (US).

Results: Prevalence of steatosis and of severe fibrosis in this cohort were 31.7% and 4.8%, respectively. ASCVD score was evaluated in patients with and without steatosis and according to the risk of severe fibrosis. By ordinal regression analysis, both steatosis (OR 1.62, 95% C.I. 1.13-2.33, p=0.009) and severity of fibrosis (OR 1.67, 95% C.I. 1.18-2.36, p=0.003) were independent risk factors for a higher ASCVD risk after adjusting for obesity. Subjects with NAFLD, when compared to those without did not differ for IMT (0.75 vs 0.72 mm; p=0.11) and IMT≥1mm (15.6% vs 12.1%; p=0.24). Higher prevalence of IMT≥1mm was found in patients at high or intermediate risk of severe fibrosis (24% and 28.6%, respectively) compared to those at low risk (12.1%) (p=0.03); this association was maintained after adjusting for confounders (OR 2.70,95%C.I. 1.01-2.86, p=0.04).

Conclusion: In the setting of a general adult population the presence of NAFLD and severe fibrosis are associated with to a higher cardiovascular risk profile, pointing towards the need for specific preventive measures.