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Published on: April 16, 2019
Cardiovascular Outcomes in Patients With Biopsy-proven Alcohol-related Liver Disease
Hannes Hagström1, Maja Thiele2, Rajani Sharma3
1Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
Insights
Patients with alcohol-related liver disease (ALD) face a doubled short-term risk of cardiovascular disease (CVD), with elevated risks seen across all liver histology subgroups. Early monitoring of CVD risk factors is crucial for ALD patients.
Area of Science:
- Hepatology
- Cardiology
- Epidemiology
Background:
- Alcohol-related liver disease (ALD) patients often have cardiovascular disease (CVD) risk factors.
- Long-term CVD risk in ALD is unclear, especially with competing liver-related mortality.
- Variation in excess CVD risk across ALD histological subgroups is unknown.
Purpose of the Study:
- To investigate the risk of CVD outcomes in individuals with biopsy-proven ALD.
- To compare CVD risk in ALD patients against a matched reference population.
- To assess if CVD risk differs across histological ALD subgroups.
Main Methods:
- A cohort study of 3488 ALD patients and 15,461 matched controls in Sweden (1969-2016).
- Utilized national diagnostic and histopathology registers for exposure and outcome data.
- Employed competing risk regression to estimate CVD hazard ratios, adjusting for confounders.
Main Results:
- ALD patients had a 2-fold increased short-term CVD risk (SHR 2.29) compared to controls.
- CVD incidence rate was 35.6 per 1000 person-years in ALD vs. 19.0 in controls.
- CVD incidence rates were similar across histological subgroups, including cirrhosis.
Conclusions:
- Biopsy-proven ALD is associated with increased CVD rates, particularly shortly after diagnosis.
- Elevated CVD risk in ALD patients persists across all histological subgroups.
- Clinicians should consider active surveillance for modifiable CVD risk factors in ALD patients.
Background & Aims:
Patients with alcohol-related liver disease (ALD) frequently have risk factors for cardiovascular disease (CVD), but their long-term risk of CVD is not well-known, especially considering the competing risk of death from liver-related causes. It is further unknown if any excess risk varies across histological subgroups.
Methods:
We investigated the risk of CVD outcomes in 3488 persons with ALD and an available liver biopsy in Sweden between 1969 and 2016, compared with a matched reference population (n = 15,461). Administrative coding from national diagnostic and histopathology registers were used to define exposures and outcomes. Competing risk regression, taking non-CVD death into account and adjusting for potential confounders, was used to estimate subdistribution hazard ratios for incident CVD up until Dec 31, 2019.
Results:
At baseline, patients with ALD had a median age of 58 years, 64% were men, and 2039 (58%) had cirrhosis on histology. The incidence rate of CVD was 35.6 per 1000 person-years in ALD compared with 19.0 per 1000 person-years in reference individuals. ALD was associated with a 2-fold increased short-term risk for CVD compared with matched reference individuals (subdistribution hazard ratio during the first year after diagnosis, 2.29; 95% confidence interval, 1.79-2.95), but this risk decreased with time. Incidence rates of CVD were comparable across histological subgroups (ranging from 27.4 CVD cases per 1000 person-years in those with normal histology to 39.2 cases per 1000 person-years in those with cirrhosis).
Conclusions:
Persons with biopsy-proven ALD have increased rates of CVD across histological subgroups compared with matched reference individuals, particularly just after ALD diagnosis. Active surveillance of modifiable CVD risk factors should be considered by clinicians treating patients with ALD.
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