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NAFLD screening not necessary prior to coronary angiogram

A majority of patients undergoing coronary angiogram had evidence of nonalcoholic fatty liver disease, suggesting an association with coronary artery stenosis. However, as mortality or cardiac complications did not increase, researchers deemed screening prior to coronary angiogram unnecessary, according to the results of a prospective cohort study published in Hepatology.

Researchers conducted a NAFLD screening via abdominal ultrasonography on 612 patients before undergoing coronary angiogram to identify high-risk patients and predict long-term outcomes. More than half (58.2%, n = 356) had NAFLD.

Patients with NAFLD were more likely to have greater than 50% coronary stenosis in one or more coronary arteries (84.6%) compared with patients without NAFLD (64.1%; P < .001). Further, more patients with NAFLD required percutaneous coronary intervention (68.3%) compared with patients without NAFLD (43.4%; P < .001).

During the course of 3,679 patient-years follow-up, 13.2% of patients with NAFLD and 23% of patients without NAFLD died (P = .003). Composite cardiovascular outcomes, such as cardiovascular deaths, nonfatal myocardial infarction, heart failure and secondary interventions, were similar between groups (36.5% vs. 37.1%; adjusted HR = 0.9; 95% CI, 0.69-1.18).

Univariate analysis showed older age, smoking and diabetes were associated with the development of cardiovascular events. Multivariate analysis showed older age and diabetes were the only independent factors associated with cardiovascular events.

Two patients with NAFLD died of primary hepatocellular carcinoma. No other patients developed liver-related complications in either group.

“NAFLD patients were more likely to have significant coronary artery disease and require coronary intervention at baseline. … However, contrary to our expectation, NAFLD patients had lower overall mortality and were not more likely to develop cardiovascular events … these argue against NAFLD screening in patients requiring coronary angiogram or having coronary artery disease,” the researchers wrote.

The researchers concluded: “Our data do not support NAFLD screening in this patient group at present, but studies with a longer duration of follow-up are needed.” – by Melinda Stevens

Disclosure: Wong reports consulting for AbbVie, Merck and NovoMedica; advising for Gilead Sciences and Janssen; and receiving lecture fees from AbbVie and Gilead Sciences. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.