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Coronary Artery Disease and Major Adverse Cardiovascular Events in People With Hepatic Steatosis at Low
Julia Karady1,2, Thomas Mayrhofer1,3, Borek Foldyna1
1Cardiovascular Imaging Research Center, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts, USA.
Insights
Hepatic steatosis (HS) increases cardiovascular event risk, even in individuals with low atherosclerotic cardiovascular disease (ASCVD) risk. This finding highlights HS as a significant, independent predictor of major adverse cardiovascular events (MACE).
Area of Science:
- Cardiology
- Hepatology
- Preventive Medicine
Background:
- Hepatic steatosis (HS) and a 10-year atherosclerotic cardiovascular disease (ASCVD) risk of ≥7.5% are independently associated with an elevated risk of cardiovascular events.
- Understanding the interplay between HS, ASCVD risk, and cardiovascular outcomes is crucial for risk stratification and preventive strategies.
Purpose of the Study:
- To evaluate the prevalence of underlying coronary artery disease (CAD) and the incidence of major adverse cardiovascular events (MACE) in patients with and without HS across different ASCVD risk strata.
- To determine if HS is an independent predictor of MACE in patients with low ASCVD risk.
Main Methods:
- Analysis of stable chest pain patients from the PROMISE trial who underwent coronary computed tomography (CT).
- HS and CAD were assessed using coronary CT. MACE included unstable angina, non-fatal myocardial infarction, and all-cause death.
- Multivariable Cox regression was employed to assess the association between HS and MACE, adjusting for CAD characteristics, particularly in patients with ASCVD risk <7.5%.
Main Results:
- Of 3702 patients, 1204 (32.5%) had ASCVD risk <7.5%, with 20.3% (244/1204) of these having HS.
- Patients with HS were younger, more frequently male, and had more risk factors compared to those without HS.
- Despite similar CAD characteristics, patients with HS exhibited significantly higher MACE rates compared to non-HS patients, both in the low (<7.5%) and high (≥7.5%) ASCVD risk groups. Notably, in the low ASCVD risk group, HS independently predicted MACE (aHR: 2.34, 95% CI: 1.01-5.43).
Conclusions:
- Individuals with hepatic steatosis and low ASCVD risk (<7.5%) have similar coronary artery disease characteristics as those without HS but experience a comparable rate of major adverse cardiovascular events as individuals with high ASCVD risk (≥7.5%).
- Hepatic steatosis is an independent predictor of MACE in patients with low ASCVD risk, suggesting it should be considered in cardiovascular risk assessment.
Background:
Hepatic steatosis (HS) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥ 7.5% are associated with increased risk for cardiovascular events.
Aim:
To assess underlying coronary artery disease (CAD) and major adverse cardiovascular event (MACE) among those with and without HS at different ASCVD risk.
Methods:
We evaluated stable chest pain patients receiving coronary computed tomography (CT) in the PROMISE trial. HS and CAD endpoints were defined on coronary CT. MACE was defined as unstable angina, non-fatal myocardial infarction, and all-cause death. Multivariable Cox regression, adjusting for CAD characteristics, assessed the association of HS with MACE for ASCVD < 7.5%.
Results:
One thousand two hundred and four of 3702 (32.5%) patients were at ASCVD < 7.5% and 20.3% (244/1204) of them had HS. Individuals with HS were younger (54.3 ± 5.2 vs. 55.8 ± 5.2; p < 0.001), more often males (40.2% [98/244] vs. 27.1% [260/960]; p < 0.001), had more risk factors/person (2.06 ± 0.89 vs. 1.93 ± 0.91; p = 0.047). CAD characteristics were similar between HS vs. non-HS patients at ASCVD < 7.5% and ASCVD ≥ 7.5% (all p > 0.05). Patients with HS had greater MACE rate compared to non-HS patients (ASCVD < 7.5%: 3.75%[9/244] vs. 1.5% [14/960]; p = 0.027 and ASCVD ≥ 7.5%: 4.7% [33/696] vs. 3.1% [56/1802]; p = 0.043). In patients without HS, MACE rate was higher in the ASCVD ≥ 7.5% vs. < 7.5% (3.1% [56/1802] vs. 1.5% [14/960]; p = 0.011). In patients with HS, MACE rates were not significantly different between ASCVD ≥ 7.5% vs. < 7.5% (4.7% [33/696] vs. 3.7% [9/244]; p = 0.484). In ASCVD < 7.5%, HS predicted MACE (aHR:2.34, 95%CI:1.01-5.43; p = 0.048), independent of CAD characteristics.
Conclusions:
Individuals with HS at ASCVD < 7.5% risk had similar CAD characteristics as patients without HS at < 7.5% ASCVD risk, yet experienced comparable MACE rates as those at ASCVD ≥ 7.5%.
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