Related Experiment Video
Updated: Sep 16, 2025
Novel In Vivo Micro-Computed Tomography Imaging Techniques for Assessing the Progression of Non-Alcoholic Fatty Liver Disease
Published on: March 24, 2023
Prognostic Significance of Fatty Liver Index for the Development of Hypertension and Cardiovascular Events in
Youngnam Bok1, Jae-Hyung Roh2, Soo Yeon An1
1Divison of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
Insights
Suboptimal blood pressure (BP) increases hypertension risk. A higher fatty liver index (FLI) independently predicts new hypertension and adverse cardiovascular events in adults with suboptimal BP.
Area of Science:
- Cardiology
- Hepatology
- Public Health
Background:
- Suboptimal blood pressure (BP) precedes hypertension and is linked to morbidity and mortality.
- Non-alcoholic fatty liver disease (NAFLD) is a growing metabolic disorder associated with cardiovascular diseases (CVDs).
Purpose of the Study:
- To investigate the association between the fatty liver index (FLI) and incident hypertension.
- To examine the link between FLI and major adverse cardiac and cerebrovascular events (MACCEs) in adults with suboptimal BP.
Main Methods:
- A cohort of 179,028 Koreans with suboptimal BP and no traditional risk factors was analyzed.
- Participants were categorized into 'normal BP' and 'high-normal BP' groups.
- Cox proportional hazards regression assessed the association between FLI quartiles and outcomes.
Main Results:
- New-onset hypertension developed in 19.36% of participants over 8.3 years, with higher incidence in the 'high-normal BP' group.
- Higher FLI quartiles were significantly associated with increased hypertension risk in both BP groups.
- MACCEs occurred in 1.87% of participants, with higher frequency in the 'high-normal BP' group. Elevated FLI was independently associated with increased MACCE risk.
Conclusions:
- A higher FLI is an independent predictor of new-onset hypertension and MACCEs in Korean adults with suboptimal BP.
- The FLI may serve as a valuable tool for identifying individuals at high risk for hypertension and adverse cardiovascular outcomes.
Background:
Suboptimal blood pressure (BP) is a precursor to clinical hypertension and is associated with BP-related morbidity and mortality. Non-alcoholic fatty liver disease, a metabolic disorder with an increasing incidence rate, is associated with cardiovascular diseases (CVDs). We investigated the association of fatty liver index (FLI) with incident hypertension and CVD outcomes in a large cohort of adults with suboptimal BP.
Methods:
We included 179,028 Koreans with suboptimal BP and no traditional risk factors from the National Health Insurance Service-National Sample Cohort, who underwent health examinations between 2009 and 2014. All subjects were divided into two groups based on their BP: 'normal BP' group (systolic BP [SBP] 120-129, diastolic BP [DBP] 80-84 mmHg), and 'high-normal BP' group (SBP 130-139, DBP 85-89 mmHg). The incidences of new-onset hypertension and major adverse cardiac and cerebrovascular events (MACCEs) were analyzed in the two groups across quartiles. Multivariate Cox proportional hazards regression analysis assessed the association between the FLI and primary outcome.
Results:
During a median follow-up of 8.3 years, 34,667 participants (19.36%) developed new-onset hypertension, which was significantly greater in the 'high-normal BP' group than in the 'normal BP' group (25.95% vs. 14.25%, P < 0.001). The incidence of new-onset hypertension was significantly higher in participants with higher FLIs according to the FLI quartile values in both groups. Additionally, 3,339 (1.87%) MACCEs were observed during the follow-up period. MACCEs occurred more frequently in the 'high-normal BP' group than in the 'normal BP group' (2.33% vs. 1.51%, P < 0.001). MACCEs were also associated with FLI quartiles. In the multivariable models adjusted for potential confounders, the hazard ratio for MACCEs comparing the highest vs. lowest quartiles of the FLI was 1.640 (95% confidence interval [CI], 1.409-1.910) and 1.363 (95% CI, 1.141-1.627) in the 'high-normal BP' group and 'normal BP' group, respectively.
Conclusion:
Over 8-9 years, 19.3% of Korean adults with suboptimal BP developed hypertension, and 1.87% experienced MACCEs without traditional risk factors. A higher FLI was independently associated with the development of hypertension and MACCEs. The FLI may be an important predictor of new-onset hypertension and adverse cardiovascular outcomes.
Related Concept Videos
01:25Ultrasound II: Endoscopic Ultrasound and FibroScan
Endoscopic Ultrasound (EUS):
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:26Atherosclerosis III: Management
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:28Factors affecting Blood pressure
Physiological Factors: