Non-alcoholic steatohepatitis and the risk of myocardial infarction: A population-based national study

Abstract

BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a systemic disease with bidirectional relationships with cardiovascular disease (CVD). Non-alcoholic steatohepatitis (NASH) is a more severe subtype of NAFLD. Patients with NASH exhibit more intra and extrahepatic inflammation, procoagulant imbalances and proatherogenic lipid profiles. Whether NASH increases the risk of ischemic heart disease is currently unclear. AIM To investigate the relationship between acute myocardial infarction (MI) and NASH in a large cohort of subjects in the United States. METHODS We reviewed data from a large commercial database (Explorys IBM) that aggregates electronic health records from 26 large nationwide healthcare systems. Using systemized nomenclature of clinical medical terms (SNOMED CT), we identified adult with the diagnosis of NASH from 1999-2019. We included patients with the diagnosis of acute MI from 2018-2019. Comorbidities known to be associated with NASH and MI such as obesity, diabetes mellitus, hyperlipidemia, smoking, male gender, and hypertension were collected. Univariable and multivariable analyses were performed to investigate whether NASH is independently associated with the risk of MI. RESULTS Out of 55099280 patients, 43170 were diagnosed with NASH (0.08%) and 107000 (0.194%) had a MI within 2018-2019. After adjusting for traditional risk factors, NASH conferred greater odds of MI odds ratio (OR) 1.5 [95% confidence interval (CI): 1.40-1.62]. Hyperlipidemia had the strongest association with MI OR 8.39 (95%CI: 8.21-8.58) followed by hypertension OR 3.11 (95%CI: 3.05-3.17) and smoking OR 2.83 (95%CI: 2.79-2.87). NASH had a similar association with MI as the following traditional risk factors like age above 65 years OR 1.47 (95%CI: 1.45-1.49), male gender OR 1.53 (95%CI: 1.51-1.55) diabetes mellitus OR 1.89 (95%CI: 1.86-1.91). CONCLUSION MI appears to be a prevalent disease in NASH. Patients with NASH may need early identification and aggressive cardiovascular risk modification.

Redox-related biomarkers in human cardiovascular disease - classical footprints and beyond

“…Importantly, non-communicable diseases represent or generate comorbidities (e.g. hyperlipidemia, hypertension or diabetes) that have great impact on cardiovascular risk and mortality [ 7 ]. These lines of evidence highlight the importance of comorbidities for the assessment of overall cardiovascular risk and the need for more and better biomarkers to characterize and provide early diagnosis of cardiovascular risk factors.…”

Nonalcoholic Fatty Liver Disease as an Emerging Risk Factor and Potential Intervention Target for Atherosclerotic Cardiovascular Diseases

“…There is a large body of evidence on the relationship between NAFLD, subclinical atherosclerosis, and more advanced atherosclerotic events presented in Table 1. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] By measuring calcification, carotid intima-media thickness (C-IMT), and stiffness of the aorta, these studies tease out whether NAFLD is an independent risk factor that could predict the development of ASCVD. [9][10][11][12][13][14][15][16] Several of these studies assessed coronary artery calcification (CAC), which is a well-established surrogate marker for atherosclerosis burden in patients with NAFLD.…”

“…There is a large body of evidence on the relationship between NAFLD, subclinical atherosclerosis, and more advanced atherosclerotic events presented in Table 1. 6–21…”

“…A growing number of studies have provided insights on the association of NAFLD with advanced atherosclerotic events such as CAD, MI, and IS. 6–8,17–21 Although the results of the study by Alexander et al biased toward the null, 17 many of these studies demonstrate the independent contribution of NAFLD to ASCVD after comprehensive adjustment of CVD risk factors. Therefore, NAFLD represents a risk enhancer for cardiovascular events.…”

Diabetes Mellitus and Heart Failure With Preserved Ejection Fraction: Role of Obesity

“…Low-grade systemic inflammation worsens cardiovascular diseases ( Dhorepatil et al, 2019 ; Ghoneim et al, 2020a , b ). It triggers/heightens an endothelial inflammatory response in the coronary microvasculature ( Paulus and Tschope, 2013 ).…”