Hepatology. 2023 Jan 19. doi: 10.1097/HEP.0000000000000286. Online ahead of print.
ABSTRACT
BACKGROUND AIMS: Nonalcoholic fatty liver disease (NAFLD) strongly associates with cardiovascular disease (CVD) risk factors; however, the association between NAFLD and incident CVD, CVD-related mortality, incident cancer, and all-cause mortality is unclear.
APPROACH RESULTS: We included 10,040 participants from the Framingham Heart Study, the Coronary Artery Risk Development in Young Adults (CARDIA) Study, and the Multi-Ethnic Study of Atherosclerosis (MESA) to assess the longitudinal association between liver fat (defined on computed tomography [CT]) and incident CVD, CVD-related mortality, incident cancer, and all-cause mortality. We performed multivariable-adjusted Cox regression models including age, sex, diabetes, systolic blood pressure, alcohol use, smoking, high-density lipoprotein, triglycerides, and body mass index (BMI) at baseline or time-varying covariates. The average age was 51.3±3.3 years and 50.6% were women. Hepatic steatosis was associated with all-cause mortality after 12.7 years of mean follow-up when adjusting for baseline CVD risk factors, including BMI [hazard ratio (HR) 1.21, 1.04-1.40]; however, results were attenuated when utilizing time-varying covariates. The association between hepatic steatosis and incident CVD was not statistically significant after we accounted for BMI in models considering baseline covariates or time-varying covariates. We observed no association between hepatic steatosis and CVD-related mortality or incident cancer.
CONCLUSIONS: In this large, multi-cohort study of participants with CT-defined hepatic steatosis, accounting for change in CVD risk factors over time attenuated associations between liver fat and overall mortality or incident CVD. Our work highlights the need to consider concurrent cardiometabolic disease when determining associations between NAFLD and CVD and mortality outcomes.
PMID:36651168 | DOI:10.1097/HEP.0000000000000286
