Non-invasive assessment of fibrosis in non-alcoholic fatty liver disease predicts cardiovascular risk in a large screening cohort

D Niederseer; A Stadlmayr; U Huber-Schönauer; D Lederer; W Patsch; E Aigner; C Datz

doi:10.1055/s-0035-1551776

Zeitschrift für Gastroenterologie, Table of Contents

Non-invasive assessment of fibrosis in non-alcoholic fatty liver disease predicts cardiovascular risk in a large screening cohort

D Niederseer ¹^,², A Stadlmayr ¹, U Huber-Schönauer ¹, D Lederer ¹, W Patsch ³, E Aigner ⁴, C Datz ¹

¹Department of Internal Medicine, General Hospital Oberndorf, Oberndorf, Austria
²Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
³Paracelsus Medical University, Salzburg, Austria
⁴First Department of Medicine, Paracelsus Medical University, Salzburg, Austria

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) and cardiovascular diseases frequently coincide due to shared risk factors. Cardiovascular events are the most common causes of death in NAFLD patients.

Objectives: To investigate whether established cardiovascular risk scores such as the Framingham risk score (FRS) and the Heart Score of the European Society of Cardiology (HS) are associated with the degree of fibrosis in NAFLD in a large screening cohort.

Material and Methods: We investigated 2138 asymptomatic subjects (59.6 ± 10.2 years, 50% males, BMI 27.2 ± 4.6 kg/m²). NAFLD was diagnosed if 1. (Significantly increased echogenicity in relation to the renal parenchyma present in ultrasound) and 2. (Exclusion of viral, autoimmune, and hereditary liver disease and excess alcohol consumption) were fulfilled. The FRS (ten-year risk of coronary heart disease), the HS (ten-year risk of fatal cardiovascular disease) and the NAFLD Fibrosis Score (NFS) were calculated for each subject. Subsequently, NFS, FRS and HS were correlated.

Results: Of 2138 subjects, 829 (38.7%) had NAFLD. Patients with NAFLD had a significantly higher cardiovascular risk: FRS: no NAFLD: 5.5 ± 5.2%; NAFLD: 8.8 ± 6.5% (p < 0.001); HS: no NAFLD: 2.9 ± 3.8%; NAFLD: 3.7 ± 4.1% (p = 0.002). In NAFLD subjects, NFS correlated significantly with FRS (r = 0.18, p < 0.001) and HS (r = 0.27, p < 0.001) in Spearman rank correlation. Patients with NAFLD were grouped into three groups according their NFS: F0-F2 (n = 663); indifferent (n = 155); F3-F4 (n = 11). In patients with F0-F2, FRS was 8.0 ± 6.1%; with indifferent NFS, 10.8 ± 6.4%; and in F3-F4: 11.5 ± 5.2%, respectively. HS showed a similar pattern: F0-F2: 3.0 ± 3.4%; with indifferent NFS, 5.4 ± 4.5%, and in F3-F4: 7.0 ± 5.7%, respectively.

Conclusions: In this large asymptomatic screening cohort, subjects with non-invasive indicators of advanced stages of NAFLD had an increased risk of coronary heart disease and cardiovascular outcomes. A multidisciplinary approach including hepatologists and cardiologists is important to ensure optimal care for these patients at high risk of CVD and liver-related endpoints.