Fatty liver predicts the risk for cardiovascular events in middle-aged population: a population-based cohort study

Abstract

ObjectiveWe investigated if the differences in liver fat content would predict the development of non-fatal and fatal atherosclerotic endpoints (coronary heart disease and stroke).Design, setting and participantsOur study group is a population-based, randomly recruited cohort (Oulu Project Elucidating Risk of Atherosclerosis, OPERA), initiated in 1991. The cohort consisted of 988 middle-aged Finnish participants.InterventionTotal mortality and hospital events were followed up to 2009 based on the registry of the National Institute for Health and Welfare and the National death registry.Main outcome measureThe severity of hepatic steatosis was measured by ultrasound and divided into three groups (0–2). Cox regression analysis was used in the statistical analysis.ResultsIn the follow-up of years 1991–2009, 13.5% of the participants with non-fatty liver, 24.2% of participants having moderate liver fat content and 29.2% of the participants having severe fatty liver experienced a cardiovascular event during the follow-up time (p<0.001). Severe liver fat content predicted the risk for future risk of cardiovascular event even when adjusted for age, gender and study group (HR 1.92, CI 1.32 to 2.80, p<0.01). When further adjustments for smoking, alcohol consumption, low-density lipoprotein-cholesterol, body mass index and systolic blood pressure were conducted, the risk still remained statistically significant (HR 1.74, CI 1.16 to 2.63, p<0.01). Statistical significance disappeared with further adjustment for QUICKI.ConclusionsLiver fat content increases the risk of future cardiovascular disease event in long-term follow-up but it is seems to be dependent on insulin sensitivity.

Non-alcoholic fatty liver disease and risk of cardiovascular disease

“…Again, increased hepatic fat content predicts the risk of CVD after adjustment for traditional risk factors, although the significance of this association was lost after further adjustment for insulin resistance [97], also suggesting that this metabolic disorder rather than increased hepatic fat content might account for excess CVD risk. These findings partly confirm that liver biopsy is not necessary in estimating CVD risk in NAFLD patients [91] and imply that non-invasive techniques, such as magnetic resonance imaging, which estimates hepatic fat content very accurately [98], might prove more useful in assessing CVD risk.…”

Association of Non-alcoholic Fatty Liver Disease with Metabolic Syndrome Independently of Central Obesity and Insulin Resistance

“…Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that is a precursor to cardiovascular disease, and patients with NAFLD have a higher rate of MetS than those without NAFLD28910. Moreover, NAFLD has also been reported to be independent of the traditional risk factors for subclinical atherosclerosis1112, cardiovascular disease (CVD)1314 and MetS15 and to increase the risk of mortality1617. Both MetS and NAFLD involve interactions of adipokines, cytokines, inflammatory factors and insulin resistance, and some researchers have proposed that NAFLD can be regarded as a hepatic manifestation of MetS918.…”

“…The exacerbation of hepatic insulin resistance promotes the development and progression of cardiovascular disease and diabetes425. Notably, more hepatic fat is associated with a higher risk of CVD1315. These findings imply that noninvasive techniques, such as MRS and liver US, with accurate measurements might be useful tools for assessing CVD risk and MetS4.…”

Non-Alcoholic Fatty Liver Disease and Cardiovascular Risk: Scientific Problem State

“…Пациенты с НАЖБП имеют высокий риск как ише-мической болезни сердца, так и инсульта [12]. Воз-можными механизмами сердечно-сосудистого риска, индуцированного НАЖБП, являются оксидативный стресс, воспаление, инсулинорезистентность, эндоте-лиальная дисфункция и продукция провоспалительных цитокинов [13].…”