Pulmonary hypertension is associated with an increased incidence of NAFLD: A retrospective cohort study of 18,910 patients

Abstract

Background Pulmonary hypertension (PH) represents a multicausal disease with increasing global incidence that eventually leads to right ventricular failure. In addition to cardiac sequelae, noncardiac comorbidities appear to be of increasing relevance, especially in times of improved therapeutic options that often result in long‐term survival. Here, we examined a potential association between PH and nonalcoholic fatty liver disease (NAFLD) as well as liver cirrhosis in an outpatient cohort in Germany. Methods A total of 9455 PH patients followed in general and internist practices between 2005 and 2019 were matched by propensity scoring based on age, sex, yearly consultation frequency and relevant comorbidities (obesity, diabetes, heart failure, lipid metabolism disorders) to a cohort of equal size without PH. The association between PH and NAFLD/liver cirrhosis was evaluated using Cox regression models. Results Within 10 years from the index date, cumulative incidence rates of NAFLD were significantly higher amongst patients with PH (7.3%) compared to non‐PH patients (3.5%, log‐rank p < 0.001). In regression analysis, this association was significant for both female (HR: 1.93, p < 0.001) and male (HR: 1.51, p = 0.005) patients and was most prominent amongst patients > 80 years (HR: 3.30, p = 0.001). Moreover, PH patients showed a strong trend towards higher incidence rates of liver cirrhosis compared to non‐PH patients (1.4 vs. 1.1%, p = 0.066). Conclusion Our data suggest that incidence rates of NAFLD are strongly elevated in patients with PH. This finding should trigger awareness of noncardiac comorbidities in these patients and argues for potential liver‐directed screening programs in patients with PH.

Infectious mononucleosis is associated with an increased incidence of NAFLD

“…The database covers approximately 3% of all outpatient practices and has previously been shown to be representative of general and specialised practices in Germany 16 . This database has already been used in studies focussing on infectious mononucleosis 17 and NAFLD 18 …”

Authors' reply: Pulmonary hypertension is associated with an increased incidence of NAFLD

“…Dear Editor, We thank the working group of Chan et al for their interest in our work and review of our manuscript [1]. In their letter, Chan et al point out the susceptibility of retrospective registry analyses to bias due to unrecognized or unconsidered risk factors [2].…”

“…We thank the working group of Chan et al. for their interest in our work and review of our manuscript [1]. In their letter, Chan et al.…”

Prognostic Value of Hepatic Native T1 and Extracellular Volume Fraction in Patients with Pulmonary Arterial Hypertension

“…Furthermore, the former patient group was more likely to develop liver cirrhosis than was the latter group. 3 The gold standard for the diagnosis and staging of liver fibrosis is liver biopsy; however, less invasive and time‐consuming and cost‐effective diagnostic methods such as transient elastography are preferred. 4 , 5 Nevertheless, both liver biopsy and transient elastography can only provide information on liver injury.…”