Hepatic steatosis and advanced hepatic fibrosis are independent predictors of long‐term mortality in acute myocardial infarction

Abstract

Aim To examine the prevalence and prognosis of hepatic steatosis and fibrosis in post‐acute myocardial infarction (AMI) patients. Methods Patients presenting with AMI to a tertiary hospital were examined from 2014 to 2021. Hepatic steatosis and advanced hepatic fibrosis were determined using the Hepatic Steatosis Index and fibrosis‐4 index, respectively. The primary outcome was all‐cause mortality. Cox regression models identified determinants of mortality after adjustments and Kaplan–Meier curves were constructed for all‐cause mortality, stratified by hepatic steatosis and advanced fibrosis. Results Of 5765 patients included, 24.8% had hepatic steatosis, of whom 41.7% were diagnosed with advanced fibrosis. The median follow‐up duration was 2.7 years. Patients with hepatic steatosis tended to be younger, female, with elevated body mass index and an increased metabolic burden of diabetes, hypertension and hyperlipidaemia. Patients with hepatic steatosis (24.6% vs. 20.9% mortality, P < .001) and advanced fibrosis (45.6% vs. 32.9% mortality, P < .001) had higher all‐cause mortality rates compared with their respective counterparts. Hepatic steatosis (adjusted hazard ratio 1.364, 95% CI 1.145‐1.625, P = .001) was associated with all‐cause mortality after adjustment for confounders. Survival curves showed excess mortality in patients with hepatic steatosis compared with those without (P = .002). Conclusions Hepatic steatosis and advanced fibrosis have a substantial prevalence among patients with AMI. Both are associated with mortality, with an incrementally higher risk when advanced fibrosis ensues. Hepatic steatosis and fibrosis could help risk stratification of AMI patients beyond conventional risk factors.

Mechanisms of Lipid Droplet Accumulation in Steatotic Liver Diseases

“…Moreover, this risk is independent of other cardiovascular risk factors or amount of cardiac arterial stenosis [85]. There is also an association between hypertension and steatosis [86], and steatosis is a predictor of mortality in acute myocardial infarction with hepatic fibrosis having only a slightly increased risk of mortality compared to steatosis [87]. Finally, steatosis more than 30% predicts graft failure when steatotic livers are transplanted [88].…”

“…84 There is also an association between hypertension and steatosis, 85 and steatosis is a predictor of mortality in acute myocardial infarction with hepatic fibrosis having only a slightly increased risk of mortality compared with steatosis. 86 Finally, steatosis more than 30% predicts graft failure when steatotic livers are transplanted. 87 While the specific mechanisms of this graft failure have not been fully established, it is likely that the aforementioned effects of LD accumulation on the hepatic microenvironment and tissue oxygenation impact graft suitability.…”

Liver fibrosis is associated with an increased risk of non‐fatal myocardial infarction

“…[8][9][10][11][12][13] Prior studies have shown that individuals at high risk of liver fibrosis according to non-invasive scores exhibit a high risk of CVD. [14][15][16][17] Comparisons among the most common non-invasive scoring systems and HFS have shown that, in cross-sectional analysis carried out in patients with biopsy-proven NAFLD, HFS has the best diagnostic performance for the identification of significant and advanced liver fibrosis, while having a moderate diagnostic accuracy at identifying patients at risk of incident CVD. 17 Accordingly, HFS was shown to have the best diagnostic performance for the identification of advanced liver fibrosis in another study carried out in patients with NAFLD or viral chronic liver disease.…”

Epicardial Adipose Tissue Assessed by Computed Tomography and Echocardiography Are Associated With Adverse Cardiovascular Outcomes: A Systematic Review and Meta-Analysis

“…4 As EAT has metabolic, thermogenic, and mechanical cardioprotective characteristics, 4 this fat deposit has been implicated in the progression of subclinical atherosclerosis and coronary artery disease. 5–10…”

“…4 As EAT has metabolic, thermogenic, and mechanical cardioprotective characteristics, 4 this fat deposit has been implicated in the progression of subclinical atherosclerosis and coronary artery disease. [5][6][7][8][9][10] Previous studies have examined the associations between EAT and heart failure, coronary artery disease, 11 and major adverse cardiovascular events (MACE). 4 Mancio and colleagues assessed the computed tomography (CT)-derived EAT volume and its relationship with coronary artery disease, and the association of EAT with increased risk of significant stenosis and MACE.…”