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NAFLD elevated risk for CVD, but not mortality

Patients with NAFLD are at an increased risk for cardiovascular disease, but not cardiovascular-related mortality, according to recent results.

Researchers evaluated data taken from a health and nutrition survey conducted from 1988-1994. The cohort included 2,492 patients with nonalcoholic fatty liver disease (NAFLD) and a 9,121-participant control group without NAFLD. Information on mortality and hepatic ultrasound results were collected for determining the prevalence of cardiovascular disease (CVD) in the two groups, as well as potential differences in CVD prevalence in NAFLD patients according to liver enzyme levels.

Patients with NAFLD were significantly more likely to experience CVD, and investigators established an independent association between the two conditions (adjusted OR=1.23; 95% CI, 1.04-1.44). This association remained after adjusting further for insulin resistance (adjusted OR=1.19; 95% CI, 1.02-1.41). Independent predictors of CVD among patients with NAFLD included advanced age, male sex, obesity, type 2 diabetes, smoking and a family history of myocardial infarction.

During a median follow-up of 171 months, 1,844 survey participants died (12.21% ± 0.60%), including 591 (3.76% ± 0.29%) because of cardiovascular issues. Overall and cardiovascular-related mortality rates were higher among patients with NAFLD compared with controls, regardless of enzyme levels. The overall mortality rate was 11.21% ± 0.64% in controls compared with 17.56% ± 1.05% in patients with NAFLD and normal enzyme levels and 16.52% ± 1.00% in patients with NAFLD (P<.0001 for all).

The mortality rate because of cardiovascular problems was 3.33% ± 0.29% in the control group, compared with 6.18% ± 0.67% in patients with NAFLD and normal enzyme levels and 5.62% ± 0.59% in patients with NAFLD (P<.0001 for all). After adjusting for confounders, the association between NAFLD and risk of cardiovascular-related mortality was not found statistically significant (adjusted HR=0.92; 95% CI, 0.70-1.19).

“The ongoing epidemic of obesity leads to consistently increasing rates of all components of metabolic syndrome, as well as NAFLD and CVD, especially in the younger population,” the researchers wrote. “Given the confirmed association of radiologically proven NAFLD with the higher risk of cardiovascular events, it is possible that the increasing prevalence of NAFLD, in addition to its hepatic consequences, also may lead to poorer prognosis because of higher cardiovascular risks and, therefore, will result in substantial mortality, morbidity and resource use.”