Alcohol Use and Cardiovascular Disease Risk in Patients With Nonalcoholic Fatty Liver Disease

Abstract

Background & Aims Cardiovascular disease (CVD) is the leading cause of death among patients with non-alcoholic fatty liver disease (NAFLD). Moderate drinking (vs abstinence) is associated with lower risk of CVD in the general population. We assessed whether alcohol use is associated with CVD risk in patients with NAFLD. Methods We analyzed data from participants in the Coronary Artery Risk Development in Young Adults longitudinal cohort study of 5115 black and white young adults, 18–30 years old, recruited from 4 cities in the United States from 1985 through 1986. Participants self-reported alcohol use at study entry and then again after 15, 20, and 25 years. At year 25 (2010–2011), participants underwent computed tomography examination of the thorax and abdomen and tissue Doppler echocardiography with myocardial strain measured by speckle tracking. Coronary artery calcification was defined as an Agatston score above 0. NAFLD was defined as liver attenuation less than 51 Hounsfield Units after exclusions. Drinkers reported 1–21 (men) or 1–14 (women) standard drinks/week at years 15, 20, or 25. Nondrinkers reported no alcohol use at years 15, 20, and 25. Results Of the 570 participants with NAFLD (mean age 50 years; 54% black; 46% female), 332 (58%) were drinkers; significantly higher proportions of drinkers were white, male, and with higher levels of education compared with nondrinkers (P<.05 for all). Higher proportions of drinkers had obesity, diabetes, and the metabolic syndrome compared with nondrinkers (P<.01). There was no difference in liver attenuation between groups (P=.12). After multivariable adjustment, there was no association between alcohol use and CVD risk factors (diabetes, hypertension, hyperlipidemia) or subclinical CVD measures (coronary artery calcification, E/A ratio, global longitudinal strain). Conclusions In a population-based sample of individuals with NAFLD in midlife, prospectively assessed alcohol use is not associated with significant differences in risk factors for CVD or markers of subclinical CVD. In contrast to general population findings, alcohol use may not reduce risk of CVD in patients with NAFLD.

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Interaction Between Alcohol Use and Metabolic Risk Factors for Liver Disease: A Critical Review of Epidemiological Studies

“…A recent study in NAFLD patients with prospectively assessed alcohol consumption over time found no association between low alcohol use and the presence of cardiovascular risk factors or subclinical cardiovascular disease (VanWagner et al, ).…”

Risks of Light and Moderate Alcohol Use in Fatty Liver Disease: Follow‐Up of Population Cohorts

“…(45) This is in contrast with a more recent study with prospectively assessed alcohol consumption over time, which found no association between alcohol use and the presence of CVD risk factors or subclinical CVD. (46) Nonetheless, clinical CVD events were not analyzed.…”