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. 2022 Nov;76(5):1495-1505.
doi: 10.1002/hep.32519. Epub 2022 Apr 23.

Risk of cardiovascular disease and loss in life expectancy in NAFLD

Ying Shang  1 , Patrik Nasr  1   2 , Linnea Widman  3 , Hannes Hagström  1   4   5
Affiliations

Risk of cardiovascular disease and loss in life expectancy in NAFLD

Ying Shang et al. Hepatology. 2022 Nov.

Abstract

Background and aims: Conflicting evidence exists on cardiovascular disease (CVD) risk in patients with NAFLD, and data are lacking on whether NAFLD increases mortality after a CVD event. Moreover, life expectancy in NAFLD has not been studied. We therefore examined CVD risk and life expectancy in patients with NAFLD compared with the general population.

Approach and results: In this nationwide population-based cohort, all patients with NAFLD diagnosis and without baseline CVD (ascertaining from the Swedish National Patient Register from 1987 to 2016, n = 10,023) were matched 10:1 on age, sex, and municipality to individuals from the general population (controls, n = 96,313). CVD diagnosis and mortality were derived from national registers. Multistate models and flexible parametric survival models were used to estimate adjusted hazard ratios (aHRs) for CVD risk and loss in life expectancy due to NAFLD. We identified 1037 (10.3%) CVD events in patients with NAFLD and 4041 (4.2%) in controls. CVD risk was 2.6-fold higher in NAFLD compared with controls (aHR = 2.61, 95% CI = 2.36-2.88) and was strongest for nonfatal CVD (aHR = 3.71, 95% CI = 3.29-4.17). After a nonfatal CVD event, the risk for all-cause mortality was similar between patients with NAFLD and controls (aHR = 0.89, 95% CI = 0.64-1.25). Life expectancy in patients with NAFLD was, on average, 2.8 years lower than controls, with the highest loss of life-years when NAFLD was diagnosed in middle age (40-60 years).

Conclusions: NAFLD was associated with a higher risk of nonfatal CVD but did not affect post-CVD mortality risk. Patients diagnosed with NAFLD have a lower life expectancy than the general population.

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Conflict of interest statement

Nothing to report.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study population. CVD, cardiovascular disease; NPR, National Patient Register; PBC, primary biliary cirrhosis; PSC, primary sclerosing cholangitis
FIGURE 2
FIGURE 2
Cumulative incidences of all CVD, nonfatal CVD, and fatal CVD by NAFLD versus matched controls (A) and by cirrhosis versus noncirrhosis in the cohort with NAFLD (B)
FIGURE 3
FIGURE 3
Associations are expressed as the HR for patients with NAFLD versus a NAFLD‐free matched cohort by the multistate model. Start of the follow‐up is a state in which participants were CVD‐free. HR due to NAFLD on the risk of transition from CVD‐free to incident CVD (A), incident CVD to death (B), or CVD‐free to death (C). All HRs were adjusted for matching variables (age, sex, municipality), type 2 diabetes, hypertension, dyslipidemia, obesity, and chronic obstructive pulmonary disease (COPD)
FIGURE 4
FIGURE 4
Average remaining life expectancy by age at diagnosis in patients diagnosed with NAFLD from 2001 to 2016
See this image and copyright information in PMC

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