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Risk of Coronary Artery Disease in Patients with Liver Cirrhosis: A Systematic Review and Meta-analysis
Chunru Gu1, Liyan Dong1, Lu Chai1,2
1Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Teaching Hospital of the China Medical University), Shenyang, Liaoning, China.
Insights
Coronary artery disease (CAD) is common in liver cirrhosis patients, but cirrhosis itself doesn't increase CAD risk. Non-alcoholic steatohepatitis and hepatitis C virus are linked to CAD in these patients.
Area of Science:
- Cardiology
- Hepatology
- Epidemiology
Background:
- Coronary artery disease (CAD) is increasingly prevalent in patients with liver cirrhosis.
- Existing data on CAD incidence and prevalence in cirrhotic patients are inconsistent, necessitating further investigation.
Purpose of the Study:
- To conduct a systematic review and meta-analysis to clarify the association between liver cirrhosis and coronary artery disease.
- To determine the incidence and prevalence of CAD in patients with liver cirrhosis.
Main Methods:
- A systematic search of PubMed, EMBASE, and Cochrane Library databases was performed.
- Incidence and prevalence data were pooled using random-effects models.
- Risk ratios and odds ratios with 95% confidence intervals were calculated to assess CAD risk in cirrhotic patients.
Main Results:
- Fifty-one studies were included, with pooled CAD incidence at 2.28% and prevalence at 18.87%.
- Liver cirrhosis was not significantly associated with increased CAD incidence (RR = 0.77) or prevalence (OR = 1.29).
- Non-alcoholic steatohepatitis, hepatitis C virus, advanced age, male sex, diabetes, hypertension, hyperlipidemia, smoking, and family history were associated with CAD in cirrhotic patients.
Conclusions:
- Coronary artery disease is common in patients with liver cirrhosis.
- Cirrhosis itself does not appear to be an independent risk factor for CAD.
- Non-alcoholic steatohepatitis and hepatitis C virus infection are significant factors associated with CAD in cirrhotic patients, alongside traditional risk factors.
Background And Aims:
Coronary artery disease (CAD) is increasingly observed in patients with liver cirrhosis. However, data on the incidence and prevalence of CAD in cirrhotic patients are heterogeneous, and the association remains uncertain. In this study, we aimed to conduct a systematic review and meta-analysis to address these issues.
Methods:
PubMed, EMBASE, and Cochrane Library databases were searched. Incidence, prevalence, and factors associated with CAD were pooled using a random-effects model. Risk ratio (RR) and odds ratio (OR), with their 95% confidence interval (CI), were calculated to evaluate differences in CAD incidence and prevalence between patients with and without liver cirrhosis.
Results:
Fifty-one studies were included. The pooled incidences of CAD, acute coronary syndromes, and myocardial infarction (MI) were 2.28%, 2.02%, and 1.80%, respectively. Liver cirrhosis was not significantly associated with CAD incidence (RR = 0.77; 95% CI = 0.46-1.28) or MI (RR = 0.87; 95% CI = 0.49-1.57). The pooled prevalence of CAD, acute coronary syndromes, and MI was 18.87%, 12.54%, and 6.12%, respectively. Liver cirrhosis was not significantly associated with CAD prevalence (OR = 1.29; 95% CI = 0.83-2.01) or MI (OR = 0.58; 95% CI = 0.28-1.22). Non-alcoholic steatohepatitis, hepatitis C virus, advanced age, male sex, diabetes mellitus, hypertension, hyperlipidemia, smoking history, and family history of CAD were significantly associated with CAD in cirrhotic patients.
Conclusions:
CAD is common in cirrhotic patients, but cirrhosis itself may not be associated with an increased CAD risk. In addition to traditional risk factors, non-alcoholic steatohepatitis and hepatitis C virus infection are also associated with CAD presence in cirrhotic patients.
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