Association of NAFLD with cardiovascular disease and all-cause mortality: a large-scale prospective cohort study based on UK Biobank

Wen Ma; Wentao Wu; Weixing Wen; Fengshuo Xu; Didi Han; Jun Lyu; Yuli Huang

doi:10.1177/20406223221122478

Association of NAFLD with cardiovascular disease and all-cause mortality: a large-scale prospective cohort study based on UK Biobank

Ther Adv Chronic Dis. 2022 Sep 20:13:20406223221122478. doi: 10.1177/20406223221122478. eCollection 2022.

Authors

Wen Ma^{1

2

3}, Wentao Wu³, Weixing Wen¹, Fengshuo Xu³, Didi Han³, Jun Lyu^{4

5}, Yuli Huang^{6

7}

Affiliations

¹ Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, P.R. China.
² Department of Clinical Research, The First Affiliated Hospital, Jinan University, Guangzhou, P.R. China.
³ School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, P.R. China.
⁴ Department of Clinical Research, The First Affiliated Hospital, Jinan University, Guangzhou 510630, P.R. China.
⁵ Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization (2021B1212040007), Guangzhou, P.R. China.
⁶ Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazi Road, Lunjiao, Shunde, Foshan 528300, P.R. China.
⁷ The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia.

Abstract

Objective: Nonalcoholic fatty liver disease (NAFLD) is considered as the hepatic manifestation of metabolic syndrome, sharing the similar cardiometabolic risk factors with cardiovascular disease (CVD). Whether NAFLD by itself is associated with increased cardiovascular events and death remain an issue to debate. This study aimed to further investigate the association between NAFLD and adverse CVD outcomes.

Methods: Participants were followed up until the end of 2020 in current analysis. NAFLD is defined using fatty liver index (FLI). Cox proportional hazard model was used to analyze the association between NAFLD and all-cause mortality, major adverse cardiovascular events (MACEs), CVD mortality, fatal/nonfatal acute myocardial infarction (AMI), and fatal/nonfatal stroke. C-index was calculated to evaluate the model enhancement when adding NAFLD factor.

Results: After screening the data of 502,492 participants in the original cohort, 215,245 eligible participants were included in this study for MACEs outcome. Compared with non-NAFLD participants, the multivariable adjusted hazard ratios of NAFLD group was 1.25 (1.14-1.36) for MACEs; 1.14 (1.08-1.20) for all-cause mortality; 1.61(1.42-1.82) for CVD mortality; 1.58(1.19-2.11) for AMI mortality; and 1.18 (0.85-1.64) for stroke mortality. When adding FLI, C-index of NAFLD model improved for all-cause mortality, MACEs, and CVD mortality compared with that in the traditional CVD risk factor model.

Conclusion: NAFLD is an independent risk factor for all-cause mortality and adverse CVD outcomes. Based on the traditional CVD risk factor model, additionally screening NAFLD could improve the prediction efficiency for adverse CVD outcomes.

Keywords: all cause mortality; cardiovascular disease; major adverse cardiovascular events; nonalcoholic fatty liver disease.

Abstract

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