Damian McNamara

October 22, 2017

WASHINGTON, DC — Women with nonalcoholic fatty liver disease (NAFLD) are at equal risk for cardiovascular events as men with fatty liver disease, according to a large population-based study, suggesting NAFLD negates the cardiovascular protective effects of being female.

"In the general population, it is known that female sex is protective for cardiovascular risk: Women are less likely than men to have cardiovascular events like heart attacks, chest pain, heart failure, or strokes," said Alina M. Allen, MD, from the Mayo Clinic in Rochester, Minnesota.

This protective effect is thought to be a result of hormonal differences, particularly up until menopause, she explained.

"What we found in the study is this does not hold true in people with NAFLD," Dr Allen said during a press conference here at The Liver Meeting 2017: American Association for the Study of Liver Diseases (AASLD).

The investigators looked at data from the Rochester Epidemiology Project for 3869 people diagnosed with NAFLD between 1997 and 2014 in Olmsted County, Minnesota. They also compiled an age- and sex-matched control cohort of 15,209 people in the general population. There were a total of 1375 cardiovascular events and 1551 deaths in the combined cohorts during a median follow-up of 7 years, up until 2016.

They then looked at rates of cardiovascular events and deaths in the two groups and found that women with NAFLD had an equal rate of cardiovascular events as men with NAFLD (hazard ratio [HR], 0.94).

"In contrast, in the general population, we found what was expected: Women have lower rates than men," Dr Allen reported. Women in the control group had a 23% lower risk of experiencing a cardiovascular event (HR, 0.77) than men in the control group.

Cardiovascular events also occurred at a younger age in women with fatty liver disease, she added. For example, the incidence of events was the same in a 50-year-old woman with NAFLD, a 53-year-old man with NAFLD, a 58-year-old man in the control group, and a 67-year-old woman in the control group.

Potential limitations of the study include the retrospective design, the use of clinical diagnosis codes, and the potential for undiagnosed NAFLD in the control group.

"We need to follow prospectively and see if this risk calculation really needs to be modified for people with NAFLD," said Dr Allen.

The risk in women in particular seems to negate the benefit that women enjoyed up until now Dr Norah Terrault

Although fatty liver disease is commonly associated with elevated rates of cirrhosis and liver cancer, "there are several epidemiologic studies that now say NAFLD is a risk factor for cardiovascular disease," said Norah Terrault, MD, from the University of California, San Francisco, who moderated the press conference.

"This adds to that, with a little twist on it, saying that the risk in women in particular seems to negate the benefit that women enjoyed up until now," she told Medscape Medical News.

The results of this study "could change our paradigm on how we think about our risk profile for women," she added.

"It's not just that you're overweight, have hyperlipidemia, or are diabetic: NAFLD, per se, is a risk factor for cardiovascular disease," said Dr Terrault.

From The Liver Meeting 2017: American Association for the Study of Liver Diseases (AASLD).

Dr Allen and Dr Terrault had no relevant financial disclosures.

Follow Medscape Gastroenterology on Twitter @MedscapeGastro and Damian McNamara @MedReporter

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