Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Apr;51(7):728-736.
doi: 10.1111/apt.15660. Epub 2020 Feb 11.

Advanced fibrosis is associated with incident cardiovascular disease in patients with non-alcoholic fatty liver disease

Jacqueline B Henson  1 , Tracey G Simon  2 , Alyson Kaplan  1 , Stephanie Osganian  2 , Ricard Masia  3 , Kathleen E Corey  2
Affiliations

Advanced fibrosis is associated with incident cardiovascular disease in patients with non-alcoholic fatty liver disease

Jacqueline B Henson et al. Aliment Pharmacol Ther. 2020 Apr.

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular disease. It is not well understood, however, which individuals with NAFLD are at highest risk for cardiovascular disease.

Aims: To determine the factors associated with incident cardiovascular events in a prospective cohort of individuals with biopsy-proven NAFLD without pre-existing cardiovascular disease.

Methods: From 2011 to 2018, adults with biopsy-proven NAFLD without cardiovascular disease were enrolled in a tissue repository and were followed prospectively to the first recorded date of incident cardiovascular disease, death or the end of follow-up (11/1/2018). Competing risks analysis was performed to identify predictors of incident cardiovascular disease.

Results: After a median follow-up time of 5.2 years, 26/285 (9.1%) individuals experienced an incident cardiovascular event. Advanced fibrosis (stage 3-4) on biopsy was a significant predictor of incident cardiovascular disease, and this persisted on multivariable analysis (SHR 2.86, 95% CI 1.36-6.04) after considering relevant covariates, including cardiovascular risk scores, which were not independent predictors. Of the non-invasive indicators of fibrosis, the NAFLD fibrosis score was the only independent predictor of cardiovascular disease. Other histologic features, including steatohepatitis, were not associated with incident cardiovascular disease.

Conclusions: In adults with biopsy-proven NAFLD, advanced fibrosis on biopsy and higher NAFLD fibrosis score were significant and independent predictors of incident cardiovascular disease, even after considering traditional risk factors and cardiovascular risk scores. These findings should be considered when evaluating NAFLD patients for primary prevention of cardiovascular disease, and further evaluation into the link between advanced fibrosis and cardiovascular disease is needed.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: none.

Figures

Figure 1.
Figure 1.
Cumulative incidence curves for incident CVD by advanced fibrosis status (A), NFS greater than or less than or equal to 0.676 (B), and NFS greater than or equal to or less than −1.455 (C). Abbreviations: CVD, cardiovascular disease; NFS, NAFLD fibrosis score.
See this image and copyright information in PMC

Comment in

References

    1. Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84. - PubMed
    1. Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149(2):389–97. - PMC - PubMed
    1. Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547–54. - PubMed
    1. Kim D, Kim WR, Kim HJ, et al. Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States. Hepatology. 2013;57(4):1357–65. - PMC - PubMed
    1. Targher G, Byrne CD, Lonardo A, et al. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: A meta-analysis. Journal of Hepatology. 2016;65:589–600. - PubMed

Publication types

MeSH terms