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Moderate alcohol use in fatty liver may protect against cardiovascular death

Significant risk factors for cardiovascular disease or markers of subclinical cardiovascular disease in adults with nonalcoholic fatty liver disease remained constant or saw a reduction with moderate alcohol use, according to a recently published prospective study.

“Results from large epidemiological studies consistently show that moderate alcohol use (compared to abstinence) is associated with lower mortality, especially among middle-aged and older men and women — an association which may reflect salutary effects of moderate alcohol consumption on coronary heart disease, diabetes, and ischemic stroke,” Lisa B. VanWagner, MD, MS, clinical fellow in the division of gastroenterology and hepatology, Northwestern University Feinberg School of Medicine, and colleagues wrote. “Identification of CVD as the leading cause of death in NAFLD raises the question of whether persons with NAFLD may benefit from moderate alcohol use.”

The researchers assessed the Coronary Artery Risk Development in Young Adults (CARDIA) ongoing longitudinal cohort, which includes black and white young adults recruited in 1985 and 1986 who were aged 18 to 30 years at the time.

VanWagner and colleagues included 570 participants from the cohort who had CT-diagnosed NAFLD. Of those, researchers classified 332 as drinkers and 238 as nondrinkers. While individuals who reported heavy alcohol consumption — defined as more than 21 drinks per week for men and more than 14 for women — were excluded from the study, the researchers included “binge drinkers,” or those who had more than 5 drinks in a setting but otherwise did not meet the heavy consumption criteria.

During assessment, the researchers found no difference in mean liver attenuation, measured systolic or diastolic blood pressure or prevalence of hypertension, or multiple lipid parameters or use of lipid-lowering medications between the group of drinkers and nondrinkers.

In both unadjusted and adjusted analyses, results showed no significant associations between alcohol use and markers of subclinical abnormalities in left ventricular mass index, left ventricular end diastolic volume, left atrial volume index, global longitudinal strain, E/A ratio, E/e’ ratio, or cardiac output. In a multivariate analysis, results showed no association between alcohol use and abnormal left ventricular relaxation or increased left ventricular filling pressures. In the year 25 analysis, there was no association between alcohol use and prevalent hypertension, hyperlipidemia, or continuous markers of hypertension or dyslipidemia.

While the researchers found differences in CVD between drinkers and nondrinkers from the CARDIA cohort who did not have NAFLD in unadjusted analyses, these results were attenuated and no longer significant when controlled for demographics and cumulative cardiometabolic risk factors.

“Despite a large body of literature on the association of moderate alcohol use with CVD in the general population, only one additional published study has specifically examined the impact of moderate alcohol use on CVD in patients with NAFLD,” the researchers concluded. “The potential ‘therapeutic window’ for the beneficial effect of alcohol use in NAFLD appears very narrow limiting the safely profile for a clinical recommendation of moderate alcohol use as a preventive measure to reduce morbidity and mortality in NAFLD.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.