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Abstract Details
Cardiovascular Morbidity and Mortality Related to Non-alcoholic Fatty Liver Disease: A Systematic Review and Meta-analysis
Curr Probl Cardiol. 2023 Feb 10;48(6):101643. doi: 10.1016/j.cpcardiol.2023.101643.Online ahead of print.
1Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
2Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Department of Clinical Sciences, Lund University, Malmö, Sweden; Fondazione VillaSerena per la Ricerca, Città Sant'Angelo, Pescara, Italy. Electronic address: fabrizioricci@hotmail.it.
3Newham University Hospital, Barts Health NHS Trust, London; Barts Heart Centre, Barts Health NHS Trust, London; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London.
4Department of Innovative Technologies in Medicine and Dentistry, "G.d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
5Center of Excellence on Headache, Geriatrics and COVID-19 Clinic, SS Annunziata Hospital of Chieti, Chieti, Italy.
6Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Cardiology, Karolinska University Hospital, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
7Fondazione VillaSerena per la Ricerca, Città Sant'Angelo, Pescara, Italy; Cardiology Division, Pisa University Hospital and University of Pisa, Pisa, Italy.
Abstract
Whether non-alcoholic fatty liver disease (NAFLD) is a cardiovascular (CV) risk factor is debated. We performed a systematic review and meta-analysis to assess the CV morbidity and mortality related to NAFLD in the general population, and to determine whether CV risk is comparable between lean and non-lean NAFLD phenotypes. We searched multiple databases, including PubMed, Embase, and the Cochrane Library, for observational studies published through 2022 that reported the risk of CV events and mortality. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for all-cause mortality, CV mortality, myocardial infarction (MI), stroke, atrial fibrillation (AF), and major adverse cardiovascular and cerebrovascular events (MACCE) were assessed through random-effect meta-analysis. We identified 33 studies and a total study population of 10,592,851 individuals (mean age 53±8; male sex 50%; NAFLD 2, 9%). Mean follow-up was 10±6 years. Pooled ORs for all-cause and CV mortality were respectively 1.14 (95% CI, 0.78-1.67) and 1.13 (95% CI, 0.57-2.23), indicating no significant association between NAFLD and mortality. NAFLD was associated with increased risk of MI (OR 1.6; 95% CI, 1.5-1.7), stroke (OR: 1.6; 95% CI, 1.2-2.1), atrial fibrillation (OR: 1.7; 95% CI, 1.2-2.3), and MACCE (OR: 2.3; 95% CI, 1.3-4.2). Compared with non-lean NAFLD, lean NAFLD was associated with increased CV mortality (OR: 1.50; 95% CI, 1.1-2.0), but similar all-cause mortality and risk of MACCE. While NAFLD may not be a risk factor for total and CV mortality, it is associated with excess risk of non-fatal CV events. Lean and non-lean NAFLD phenotypes exhibit distinct prognostic profiles and should receive equitable clinical care.