Mortality Risk Detected by Atherosclerotic Cardiovascular Disease Score in Patients With Nonalcoholic Fatty Liver
Pegah Golabi1, Natsu Fukui2, James Paik1
1Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA.
Insights
Patients with nonalcoholic fatty liver disease (NAFLD) and high atherosclerotic cardiovascular disease (ASCVD) risk scores face increased overall and cardiac mortality. Early identification and intervention are crucial for this high-risk population.
Area of Science:
- Cardiology
- Hepatology
- Public Health
Background:
- Cardiovascular diseases (CVDs) are the primary cause of death in nonalcoholic fatty liver disease (NAFLD) patients.
- Assessing CVD risk in NAFLD is critical for improving patient outcomes.
Purpose of the Study:
- To evaluate the association between atherosclerotic cardiovascular disease (ASCVD) risk scores and mortality in patients with NAFLD.
- To determine the impact of high ASCVD risk on both overall and cardiac-specific mortality.
Main Methods:
- Utilized data from the National Health and Nutrition Examination Survey III linked to mortality files.
- Defined NAFLD by ultrasound and high CVD risk as a 10-year ASCVD score ≥7.5%.
- Calculated hazard ratios (HRs) and population-attributable fractions (PAFs) for mortality.
Main Results:
- Among 1,262 NAFLD patients, 55.9% had high CVD risk.
- High CVD risk was significantly associated with a 42% increased overall mortality (aHR, 1.42) and doubled cardiovascular mortality risk (aHR, 2.02).
- Population-attributable fractions indicated high ASCVD risk accounted for 11.4% of overall and 44.9% of cardiovascular deaths.
Conclusions:
- An ASCVD score of ≥7.5% identifies NAFLD patients at significantly higher risk of overall and cardiac mortality.
- These findings underscore the importance of integrating CVD risk assessment into NAFLD management.
- Targeting high-risk NAFLD individuals could substantially reduce cardiovascular and overall mortality.
Abstract:
Cardiovascular diseases (CVDs) are the leading cause of mortality in patients with nonalcoholic fatty liver disease (NAFLD). Our aim was to assess the association of atherosclerotic cardiovascular disease (ASCVD) risk scores with overall and cardiac-specific mortality among patients with NAFLD. We used the National Health and Nutrition Examination Survey III with the National Death Index-linked mortality files. NAFLD was defined by ultrasound as presence of steatosis in the absence of secondary causes of liver disease. High risk for CVD was defined as a 10-year ASCVD score ≥7.5%. Hazard ratios (HRs) and population-attributable fractions (PAFs) of high risk for CVD were calculated. Among 1,262 subjects with NAFLD (47.9% men; 41.2% white; mean age, 56.3 years), the prevalence of high risk for CVD was 55.9% and 4.8% had advanced fibrosis. After a median follow-up of 17.7 years, 482 subjects (38.2%) died of overall causes, of whom 382 (79.3%) had a high risk for CVD. The unadjusted overall and cardiac-specific mortality were higher for patients with NAFLD who had a high risk for CVD compared to subjects with NAFLD with a low risk for CVD (57.3% vs. 16.8% for overall mortality; 16.4% vs. 3.5% for cardiovascular mortality). After controlling for risk factors associated with mortality, high risk for CVD was associated with a 42% higher overall mortality rate (adjusted HR [aHR], 1.42; 95% confidence interval [CI], 1.05-1.91) and twice the risk of cardiovascular mortality (aHR, 2.02; 95% CI, 1.12-3.65). Adjusted PAFs were 11.4% for overall mortality and 44.9% for cardiovascular mortality. Conclusion: Among patients with NAFLD, ASCVD score ≥7.5% was associated with a higher risk of overall and cardiac-specific mortality.
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