Interplay between non-alcoholic fatty liver disease and cardiovascular risk in an asymptomatic general population

Abstract

BACKGROUND AND AIMS: Nonalcoholic fatty liver (NAFLD) is a major cause of liver disease worldwide leading also to a higher risk of cardiovascular events. We aimed to evaluate the impact of fatty liver and fibrosis on cardiovascular risk in a general population.METHODS: 542 subjects included in the community-based ABCD (Alimentazione, Benessere Cardiovascolare e Diabete) study were recruited. Steatosis (CAP > 288 dB/m) and severe fibrosis (Low risk, LSM < 7.9 KPa with M probe and < 5.7 KPa with XL probe; intermediate risk, LSM 7.9-9.5 KPa with M probe and 5.7-9.2 KPa with XL probe; high risk, LSM ≥9.6 KPa with M probe and ≥9.3 KPa with XL probe) were assessed with FibroScan. Cardiovascular risk was evaluated by the Atherosclerotic Cardiovascular Disease (ASCVD) risk estimator and defined low if < 5%, borderline if 5%-7.4%, intermediate if 7.5%-19.9% and high if ≥20%. Intima-media thickness (IMT) was measured with ultrasound (US).RESULTS: Prevalence of steatosis and of severe fibrosis in this cohort were 31.7% and 4.8%, respectively. ASCVD score was evaluated in patients with and without steatosis and according to the risk of severe fibrosis. By ordinal regression analysis, both steatosis (OR 1.62, 95% C.I. 1.13-2.33, p=0.009) and severity of fibrosis (OR 1.67, 95% C.I. 1.18-2.36, p=0.003) were independent risk factors for a higher ASCVD risk after adjusting for obesity. Subjects with NAFLD, when compared to those without did not differ for IMT (0.75 vs 0.72 mm; p=0.11) and IMT≥1mm (15.6% vs 12.1%; p=0.24). Higher prevalence of IMT≥1mm was found in patients at high or intermediate risk of severe fibrosis (24% and 28.6%, respectively) compared to those at low risk (12.1%) (p=0.03); this association was maintained after adjusting for confounders (OR 2.70,95%C.I. 1.01-2.86, p=0.04).CONCLUSION: In the setting of a general adult population the presence of NAFLD and severe fibrosis are associated with to a higher cardiovascular risk profile, pointing towards the need for specific preventive measures.