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
Meta-Analysis
. 2021 Dec;8(2):e001850.
doi: 10.1136/openhrt-2021-001850.

Association between non-alcoholic fatty liver disease and subclinical atherosclerosis in Western and Asian cohorts: an updated meta-analysis

Mark Yu Zheng Wong #  1 , Jonathan Jiunn Liang Yap #  1   2 , Rehena Sultana  2 , Mark Cheah  3 , George Boon Bee Goh  2   3 , Khung Keong Yeo  4   2
Affiliations
Meta-Analysis

Association between non-alcoholic fatty liver disease and subclinical atherosclerosis in Western and Asian cohorts: an updated meta-analysis

Mark Yu Zheng Wong et al. Open Heart. 2021 Dec.

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is a well-established risk factor for cardiovascular disease, with ethnic and regional differences noted. With the recent surge of research within this field, we re-examine the evidence associating NAFLD with subclinical atherosclerosis, and investigate potential regional differences.

Methods: This is a systematic review and meta-analysis. PubMed and EMBASE were systematically searched for publications from January 1967 to July 2020 using standardised criteria. Original, observational studies investigating the association between NAFLD and either carotid intima-media thickness (CIMT) and/or coronary artery calcification (CAC) were included. Key outcomes included differences in mean CIMT, the presence of increased CIMT, the presence of CAC and the development/progression of CAC. Pooled ORs and pooled standard differences in means were calculated using random-effects models. Between-study heterogeneity was quantified using the Q statistic and I². Subgroup analyses stratified by region of study (Asian vs Western) were also conducted.

Results: 64 studies involving a total of 172 385 participants (67 404 with NAFLD) were included. 44 studies assessed the effect of NAFLD on CIMT, with the presence of NAFLD associated with increased CIMT (OR 2.00, 95% CI 1.56 to 2.56). 22 studies assessed the effects of NAFLD on CAC score, with the presence of NAFLD associated with the presence of any coronary calcification (OR 1.21, 95% CI 1.12 to 1.32), and the development/progression of CAC (OR 1.26, 95% CI 1.04 to 1.52). When stratified by region, these associations remained consistent across both Asian and Western populations (p>0.05). The majority (n=39) of studies were classified as 'high quality', with the remaining 25 of 'moderate quality'.

Conclusions: There is a significant positive association between various measures of subclinical atherosclerosis and NAFLD, seen across both Western and Asian populations. These results re-emphasise the importance of early risk evaluation and prophylactic intervention measures to preclude progression to clinical cardiovascular disease in patients with NAFLD.

Keywords: atherosclerosis; meta-analysis; metabolic syndrome.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study selection PRISMA flow diagram. CAC, coronary artery calcification; CIMT, carotid intima-media thickness; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Forest plots showing relationship between NAFLD and presence of increased CIMT. CIMT, carotid intima-media thickness; NFLD, non-alcoholic fatty liver disease.
Figure 3
Figure 3
(A) Forest plots showing pooled standard differences in unadjusted CIMT means between NAFLD(+) and NAFLD(−) groups. (B) Forest plots showing pooled standard differences in adjusted CIMT means between NAFLD(+) and NAFLD(−) groups. CIMT, carotid intima-media thickness; NFLD, non-alcoholic fatty liver disease.
Figure 4
Figure 4
(A) Forest plots showing relationship between NAFLD and presence of increased CIMT, stratified by region of study. (B) Forest plots showing pooled standard differences in CIMT means between NAFLD(+) and NAFLD(−) groups, stratified by region of study. CIMT, carotid intima-media thickness; NFLD, non-alcoholic fatty liver disease.
Figure 5
Figure 5
(A) Forest plots showing relationship between NAFLD and CAC scores >0 and >100. (B) Forest plots showing relationship between NAFLD and the development/progression of CAC. CAC, coronary artery calcification; NFLD, non-alcoholic fatty liver disease.
Figure 6
Figure 6
(A) Forest plots showing relationship between NAFLD and CAC score >0, stratified by region of study. (B) Forest plots showing relationship between NAFLD and CAC score >100, stratified by region of study. CAC, coronary artery calcification; NFLD, non-alcoholic fatty liver disease.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346:1221–31. 10.1056/NEJMra011775 - DOI - PubMed
    1. Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol 2013;10:330–44. 10.1038/nrgastro.2013.41 - DOI - PubMed
    1. Stahl EP, Dhindsa DS, Lee SK, et al. . Nonalcoholic fatty liver disease and the Heart: JACC state-of-the-art review. J Am Coll Cardiol 2019;73:948–63. 10.1016/j.jacc.2018.11.050 - DOI - PubMed
    1. Loomba R, Sanyal AJ. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol 2013;10:686–90. 10.1038/nrgastro.2013.171 - DOI - PubMed
    1. Adams LA, Anstee QM, Tilg H, et al. . Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut 2017;66:1138–53. 10.1136/gutjnl-2017-313884 - DOI - PubMed

Publication types

MeSH terms