Sex differences in cardiovascular diseases and associated risk factors in non-alcoholic steatohepatitis

Non-alcoholic steatohepatitis (NASH) is well recognized as an important cardiovascular disease (CVD) risk factor. However, not many studies have described the prevalence of traditional CVD risk factors and CV diseases, and respective sex differences, in patients with NASH.

In this retrospective observational cohort study using the 2016 US National Readmissions Database, we studied adults with NASH to identify the prevalence of important CVD risk factors like age, obesity, hypertension, diabetes mellitus, renal failure, dyslipidemia, smoking, and drug abuse and cardiovascular diseases like coronary artery disease, myocardial infarction and coronary revascularization, peripheral vascular disease, cerebrovascular disease, and pulmonary vascular disease. We studied sex differences using the Pearson χ² test for categorical variables, student t-test for continuous variables, and logistic regression for age-adjusted analysis.

Our study sample included 41,005 patients with NASH of which 15,758 (38.4%) were male and 25,247 (61.6%) were female. Hypertension was the most prevalent CVD risk factor (68%), followed by diabetes mellitus (62%), obesity (40%), dyslipidemia (37%), smoking (30%), and renal failure in 27%. Of the cardiovascular diseases studied, coronary artery disease (20.6%) and heart failure (19.6%) were highly prevalent followed by peripheral vascular disease (5.7%), stroke (4.7%), and pulmonary vascular disease (1.4%). Men had higher rates of most risk factors and diseases compared with women, except for higher rates of obesity and diabetes mellitus in women and a similar rate of drug abuse, stroke, and pulmonary vascular disease between the sex groups.

In patients with NASH, CVD risk factors and diseases were highly prevalent and important sex differences were present.