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Woolley JJ, Fishman J, Parrinello CM, O'Connell T. Cardiovascular risk in US adults with nonalcoholic steatohepatitis (NASH) vs. matched non-NASH controls, National Health and Nutrition Examination Survey, 2017-2020. PLoS One 2024; 19:e0309617. [PMID: 39190769 DOI: 10.1371/journal.pone.0309617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND NASH is considered a contributor to atherosclerotic cardiovascular disease (ASCVD) risk; however, its contribution beyond traditional risk factors for CVD, particularly diabetes, is less clearly understood. This study aimed to quantify the cardiovascular-event risk associated with NASH, independent of diabetes status. METHODS A cross-sectional analysis was conducted using the 2017-2020 NHANES pre-pandemic cycle. NASH was defined based on presence of steatosis without other causes of liver disease, and FibroScan+AST score from vibration-controlled transient elastography (VCTE). Significant fibrosis (stages F2-F4) was identified by liver stiffness measurement from VCTE. Predicted primary CV-event risk was estimated using both the Pooled Cohort Equations (PCE) and the Framingham Risk Score (FRS). NASH patients were matched with non-NASH controls on age, sex, race/ethnicity, and diabetes status. Weighted logistic regression was conducted, modeling elevated predicted CV risk (binary) as the dependent variable and indicators for NASH / fibrosis stages as independent variables. RESULTS A sample of 125 NASH patients was matched with 2585 controls. NASH with significant fibrosis was associated with elevated predicted 10-year CV risk, although this association was only statistically significant in PCE analyses (odds ratio and 95% CI 2.34 [1.25, 4.36]). Analyses restricting to ages <65 years showed similar results, with associations of greater magnitude. CONCLUSION Independent of diabetes, a significant association was observed between NASH with significant liver fibrosis and predicted primary CV-event risk in US adults, particularly for those <65. These findings suggest the importance of accounting for NASH and liver-fibrosis stage in predicting CV-event risk.
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Affiliation(s)
| | - Jesse Fishman
- Formerly of Madrigal Pharmaceuticals, Conshohocken, Pennsylvania, United States of America
| | | | - Tom O'Connell
- Medicus Economics, Boston, Massachusetts, United States of America
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Hazzan R, Abu Ahmad N, Habib AS, Saleh I, Ziv N. Suboptimal reliability of FIB-4 and NAFLD-fibrosis scores for staging of liver fibrosis in general population. JGH Open 2024; 8:e13034. [PMID: 38380260 PMCID: PMC10877654 DOI: 10.1002/jgh3.13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/02/2024] [Accepted: 01/16/2024] [Indexed: 02/22/2024]
Abstract
Background and Aim The burden and incidence of liver cirrhosis are increasing worldwide. Early detection of liver fibrosis would help in early interventions and preventing the progression of fibrosis and cirrhosis. The accepted noninvasive markers for liver fibrosis staging, namely fibrosis-4 (FIB-4) and nonalcoholic fatty liver disease fibrosis score (NFS), have shown inconsistent performance for detecting the fibrosis stage. We aimed to evaluate the efficacy of FIB-4 score and NFS for the detection of liver fibrosis in the general population. Methods From a general population referred from a single, community-based family-physician clinic, we included study participants between the ages of 45 and 65 years, with no knowledge of liver disease and no record of alcohol consumption. Liver fibrosis was evaluated by the FIB-4 score and NFS using shear wave elastography (SWE) or transient elastography (TE) measurements as a reference. Results A total of 76 participants (aged 61.5 ± 0.37 years, 33% females) were included in the study cohort. We observed a nonsignificant correlation between liver stiffness measurement (LSM) and FIB-4 and NFS (r = 0.1, P = 0.37; r = 0.16, P = 0.15, respectively). Our results showed that only 5.2% with FIB-4 >3.25 and 9.7% with NFS >0.675 had LSM >12 kPa. The compatibility of fibrosis staging was 55% between FIB-4 score and LSM and only 18% between NFS and LSM. Conclusion We found that FIB-4 and NFS are unreliable tools for liver fibrosis estimation in the general population. There is a need for more reliable noninvasive methods for the early detection of liver fibrosis.
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Affiliation(s)
| | | | | | | | - Neeman Ziv
- Diagnostic Imaging InstituteEmek Medical CenterAfulaIsrael
- The Faculty of MedicineTechnion Institute of TechnologyHaifaIsrael
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Beer S, Babel J, Martin N, Blank V, Wiegand J, Karlas T. Non-invasive assessment of steatohepatitis indicates increased risk of coronary artery disease. PLoS One 2023; 18:e0286882. [PMID: 37768969 PMCID: PMC10538770 DOI: 10.1371/journal.pone.0286882] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/25/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Fatty liver diseases (FLD), especially defined as metabolic dysfunction-associated FLD (MAFLD), is of growing importance for patients and health-care providers. Extrahepatic comorbidities, predominantly coronary artery disease (CAD), contribute to excess morbidity and mortality in FLD. Although the association of FLD and CAD is well known, underlying pathophysiological links are not fully understood. Non-invasive means of liver diagnostic enable a fast and thorough characterization of FLD. We therefore assessed the severity of FLD in a cohort of patients at risk of CAD. METHODS Patients scheduled for coronary angiography were characterized by anthropometry, serum-based indices of liver fibrosis (NFS, FIB4), abdominal ultrasound and vibration controlled transient elastography (VCTE) including controlled attenuation parameter (CAP) and the Fibroscan-AST (FAST) score. Patients were stratified according to indication of therapeutic coronary intervention. RESULTS 120 patients were recruited, MAFLD was found in 41%, while advanced fibrosis or cirrhosis were present in only 5%. Coronary vascular intervention was indicated in 42% (n = 50). Severity of steatosis assessed by CAP and risk of fibrosis defined by elevated liver stiffness (VCTE>8 kPa) and fibrosis indices were associated with the need for coronary intervention. FAST score, a marker of fibrotic steatohepatitis, was elevated in the intervention group (0.22 vs. 0.12, p<0.001). Multivariate regression analysis revealed FAST score as strongest predictor of CAD (OR 2.3 95%, CI 1.40-2.96). DISCUSSION MAFLD is a frequent comorbidity in patients at CAD risk, but advanced liver disease has a low prevalence in patients undergoing elective coronary angiography. Therefore, a routine VCTE-based screening for FLD cannot be recommended in cardiac patients. The association of indicators of steatohepatitis with advanced CAD points to inflammatory processes as a conjoint mechanism of both diseases.
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Affiliation(s)
- Sebastian Beer
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center, Leipzig, Germany
- Integrated Research and Treatment Center Adiposity Diseases, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Jonas Babel
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center, Leipzig, Germany
- Department of Operative Medicine II, Division of Visceral-, Transplant-, Thoracic- and Vascular Surgery, Leipzig University Medical Center, Leipzig, Germany
| | - Neef Martin
- Department of Cardiology, Leipzig University Medical Center, Leipzig, Germany
| | - Valentin Blank
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center, Leipzig, Germany
- Department of Internal Medicine I (Gastroenterology, Pneumology) and Division of Interdisciplinary Ultrasound, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Johannes Wiegand
- Department of Medicine II, Division of Hepatology, Leipzig University Medical Center, Leipzig, Germany
| | - Thomas Karlas
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center, Leipzig, Germany
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Namakchian M, Rabizadeh S, Seifouri S, Asadigandomani H, Bafrani MA, Seifouri K, Avanaki FA, Rajab A, Nakhjavani M, Esteghamati A. Fibrosis score 4 index has an independent relationship with coronary artery diseases in patients with metabolic-associated fatty liver disease. Diabetol Metab Syndr 2023; 15:57. [PMID: 36964605 PMCID: PMC10039491 DOI: 10.1186/s13098-023-01031-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Metabolic-associated fatty liver disease (MAFLD), one of the most common liver diseases, is detected in patients with concomitant hepatic steatosis and Type 2 Diabetes (T2D). We looked into the relationship between Fibrosis-4 (FIB-4) index and coronary artery diseases (CAD) in patients with MAFLD, to further look into the efficiency of FIB-4 in screening for CAD among patients with MAFLD. METHOD In this study, we included 1664 patients with MAFLD (T2D, who also had hepatic steatosis) during 2012-2022 and divided them into 2 groups; CAD and non-CAD. Demographic, Anthropometric indices, liver function tests, lipid profile and FIB-4 index of all patients were evaluated and compared. RESULT Among the 1644 patients (all have MAFLD), 364(21.4%) had CAD. Patients with MAFLD and CAD were more probable to be hypertensive, have longer duration of diabetes and be older (with p-values < 0.001). After adjustment for confounding factors, in a multivariable logistic regression model, FIB4 showed a significant independent relationship with concomitant MAFLD and CAD. Upper Tertile FIB-4 had an odds ratio of 3.28 (P-value = 0.002) to predict CAD. Furthermore, in Receiver Operating Characteristic (ROC) Curve analysis with the maximum Youden Index, a FIB-4 cut-off of 0.85 (AUC = 0.656, 95% CI 0.618-0.693, P < 0.001) noted to predict CAD in patients with MAFLD. CONCLUSION This study showed that the FIB-4 score independently correlates with CAD in patients with MAFLD.
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Affiliation(s)
- Maryam Namakchian
- Endocrinology and Metabolism Research Center (EMRC), Imam Khomeini Hospital Complex, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, 13145-784 Iran
| | - Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC), Imam Khomeini Hospital Complex, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, 13145-784 Iran
| | - Sara Seifouri
- Endocrinology and Metabolism Research Center (EMRC), Imam Khomeini Hospital Complex, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, 13145-784 Iran
| | - Hassan Asadigandomani
- Endocrinology and Metabolism Research Center (EMRC), Imam Khomeini Hospital Complex, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, 13145-784 Iran
| | - Melika Arab Bafrani
- Endocrinology and Metabolism Research Center (EMRC), Imam Khomeini Hospital Complex, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, 13145-784 Iran
| | - Kiana Seifouri
- Endocrinology and Metabolism Research Center (EMRC), Imam Khomeini Hospital Complex, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, 13145-784 Iran
| | - Foroogh Alborzi Avanaki
- Departments of Gastroenterology and Hepatology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Armin Rajab
- Endocrinology and Metabolism Research Center (EMRC), Imam Khomeini Hospital Complex, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, 13145-784 Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Imam Khomeini Hospital Complex, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, 13145-784 Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Imam Khomeini Hospital Complex, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, 13145-784 Iran
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Cazac GD, Lăcătușu CM, Mihai C, Grigorescu ED, Onofriescu A, Mihai BM. New Insights into Non-Alcoholic Fatty Liver Disease and Coronary Artery Disease: The Liver-Heart Axis. Life (Basel) 2022; 12:1189. [PMID: 36013368 PMCID: PMC9410285 DOI: 10.3390/life12081189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/17/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) represents the hepatic expression of the metabolic syndrome and is the most prevalent liver disease. NAFLD is associated with liver-related and extrahepatic morbi-mortality. Among extrahepatic complications, cardiovascular disease (CVD) is the primary cause of mortality in patients with NAFLD. The most frequent clinical expression of CVD is the coronary artery disease (CAD). Epidemiological data support a link between CAD and NAFLD, underlain by pathogenic factors, such as the exacerbation of insulin resistance, genetic phenotype, oxidative stress, atherogenic dyslipidemia, pro-inflammatory mediators, and gut microbiota. A thorough assessment of cardiovascular risk and identification of all forms of CVD, especially CAD, are needed in all patients with NAFLD regardless of their metabolic status. Therefore, this narrative review aims to examine the available data on CAD seen in patients with NAFLD, to outline the main directions undertaken by the CVD risk assessment and the multiple putative underlying mechanisms implicated in the relationship between CAD and NAFLD, and to raise awareness about this underestimated association between two major, frequent and severe diseases.
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Affiliation(s)
- Georgiana-Diana Cazac
- Unit of Diabetes, Nutrition and Metabolic Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Clinical Center of Diabetes, Nutrition and Metabolic Diseases, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Cristina-Mihaela Lăcătușu
- Unit of Diabetes, Nutrition and Metabolic Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Clinical Center of Diabetes, Nutrition and Metabolic Diseases, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Cătălina Mihai
- Institute of Gastroenterology and Hepatology, “Sf. Spiridon” Emergency Hospital, 700111 Iași, Romania
- Unit of Medical Semiology and Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena-Daniela Grigorescu
- Unit of Diabetes, Nutrition and Metabolic Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Alina Onofriescu
- Unit of Diabetes, Nutrition and Metabolic Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Clinical Center of Diabetes, Nutrition and Metabolic Diseases, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Bogdan-Mircea Mihai
- Unit of Diabetes, Nutrition and Metabolic Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Clinical Center of Diabetes, Nutrition and Metabolic Diseases, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
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