Nonalcoholic Fatty Liver Disease, Liver Fibrosis and Cardiovascular Disease in the Adult US Population

Abstract

Background: Cardiovascular disease (CVD) risk is higher in patients with nonalcoholic fatty liver disease (NAFLD).

Aim: To evaluate whether this can be attributed to the link between NAFLD and known CVD risk factors or to an independent contribution of liver steatosis and fibrosis.

Methods: This is an analysis of data from the 2017-2018 cycle of the National Health and Nutrition Examination Survey. We included participants older than 40 years with available data on vibration-controlled transient elastography (VCTE) and without viral hepatitis and significant alcohol consumption. Steatosis and fibrosis were diagnosed by the median value of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively. History of CVD was self-reported and defined as a composite of coronary artery disease and stroke/transient ischemic attacks.

Results: Among the 2734 included participants, prevalence of NAFLD was 48.6% (95% CI 45.1-51.4), 316 participants (9.7%, 95% CI 8.1-11.6) had evidence of significant liver fibrosis and 371 (11.5%, 95% CI 9.5-13.9) had a history of CVD. In univariate analysis, patients with CVD had a higher prevalence of steatosis (59.6% vs 47.1%, p=0.013), but not fibrosis (12.9% vs 9.3%, p=0.123). After adjustment for potential confounders in a multivariable logistic regression model, neither steatosis nor significant fibrosis were independently associated with CVD and heart failure.

Conclusions: In this population-based study, we did not identify an independent association between steatosis and fibrosis and CVD. Large prospective cohort studies are needed to provide a more definitive evidence on this topic.

Keywords: CVD; MAFLD; NAFLD; fibroscan and transient elastography; fibrosis.

Figure 1

Flow-chart of the study participants. NHANES, National Health and Nutrition Examination Survey.

Figure 2

Multivariable logistic regression model evaluating the effect of several predictors on the presence of (A) cardiovascular disease (CVD) and (B) heart failure (HF). Reference categories for cigarette smoke were never smoker, while the reference category for race-ethnicity was non-Hispanic white. BMI, body mass index; CAP, controlled attenuation parameter; LSM, liver stiffness measurement; CKD, chronic kidney disease.