Women with NAFLD lose sex-associated cardiovascular protection

Women who developed nonalcoholic fatty liver disease no longer retained the cardiovascular protective effect conferred by female sex, according to a study published in American Journal of Gastroenterology.

“Unlike women from the general population, who are 29% less likely to develop CVD than their male counterparts with similar [cardiovascular] risk factors, NAFLD women have a similar CVD risk as NAFLD men,” Alina M. Allen, MD, from the Mayo Clinic in Rochester, Minnesota, and colleagues wrote.

The study comprised 3,869 patients with NAFLD and 15,209 age- and sex-matched individuals without NAFLD. Women comprised 52.4% of the whole cohort and were more likely to have a higher BMI, diabetes and hypertension compared with men.

During follow-up, women demonstrated a lower risk for incident ischemic events compared with controls without NAFLD (HR = 0.72; 95% CI, 0.65-0.8), but the sex-associated protection diminished in those with NAFLD (HR = 0.93; 95% CI, 0.78-1.09).

Multivariate analysis confirmed that female sex remained a protective factor for ischemic cardiovascular events (HR = 0.71; 95% CI, 0.62-0.8) except for those with NAFLD (HR = 0.9; 95% CI, 0.74-1.08).

Additionally, the incidence rate for cardiovascular events was especially higher in women with NAFLD a younger age vs. women in the control group, with approximately 30 events per 1,000 person-years occurring around age 68 for the control group and around age 50 years for those with NAFLD.

“Current equations underestimate the 10-year [atherosclerotic CVD] risk in NAFLD women while overestimating the risk in the general population,” Allen and colleagues wrote. “These findings have important clinical implications, as they could impact counseling and adequate initiation of primary prevention methods with aspirin and statins in women with NAFLD.” – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.