NAFLD Not Associated With Risk of Cardiovascular Disease

By Reuters Staff

October 27, 2019

NEW YORK (Reuters Health) - Non-alcoholic fatty liver disease (NAFLD) is not associated with an increased risk of acute myocardial infarction (AMI) or stroke, according to a new cohort study in nearly 18 million Europeans.

"For the time being, it should not be assumed that people with a diagnosis of NAFLD are automatically at increased risk of AMI or stroke. Rather, it is important to do a cardiovascular-risk assessment in people with a diagnosis of NAFLD, in addition to checking for undiagnosed diabetes," Dr. Myriam Alexander of GlaxoSmithKline in Uxbridge, U.K., and colleagues conclude in their report, online October 8 in The BMJ.

While NAFLD incidence has risen globally, in tandem with obesity and diabetes, it’s not clear whether the condition has independent effects on cardiovascular risk, Dr. Alexander and her team note. To investigate, they looked at electronic primary healthcare databases from Italy, the Netherlands, Spain and the U.K., including a total of 17.7 million patients.

During follow-up, which lasted a mean of 2.1 to 5.5 years, 120,795 patients were diagnosed with NAFLD or non-alcoholic steatohepatitis (NASH).

The pooled hazard ratio associated with NAFLD or NASH after adjusting for smoking and age was 1.17 (95% confidence interval, 1.05 to 1.30) for AMI and 1.18 (95% CI, 1.11 to 1.24) for stroke after adjustment for age and smoking.

However, in a subset of more than 86,000 NAFLD patients and some 4.6 million matched controls with more complete data on risk factors, the AMI hazard ratio was 1.01 after adjusting for systolic blood pressure, type 2 diabetes, total cholesterol, statin use and hypertension. The adjusted hazard ratio for stroke was 1.04. Neither was significantly different from unity.

"A diagnosis of NAFLD does warrant risk assessment for the stage of liver disease, and behaviour and lifestyle advice not only for reduction of liver fat but also for benefits of weight loss on AMI and stroke risk factors, including lipids, systolic blood pressure, and the development of diabetes," Dr. Alexander and colleagues write.

They conclude: "Among the large numbers of patients with NAFLD, some, if not many, could be at increased risk of AMI and stroke outcomes. Further study is, however, needed to identify such people and quantify that risk."


BMJ 2019.