Association between non-alcoholic fatty liver disease and risk of incident heart failure: a meta-analysis of observational studies

Abstract

Background and aims: Recent research has associated non-alcoholic fatty liver disease (NAFLD) with an increased risk of atherosclerotic cardiovascular disease. Previous studies that evaluated the association between NAFLD and risk of heart failure (HF) yielded inconsistent results, however. This meta-analysis aimed to evaluate the association between NAFLD and the risk of HF. Methods: We searched multiple electronic databases, including PubMed, Google Scholar, Embase and Web of Science for potential studies published from inception until 30 October 2021. Cohort studies reported multivariable-adjusted risks of incident HF in NAFLD patients comparing those without NAFLD were included. Results: Six cohort studies comprising 10,979,967 participants (women = 55.5%) were included in the study. The median prevalence of NAFLD in these studies was 22.2%. During a median follow-up duration of 7.0 years, 92,915 HF cases were detected. In the unadjusted model, patients with NAFLD had a greater risk of incident HF [random-effect hazard ratio (HR) = 1.47, 95% confidence interval (CI) = 1.25–1.75, I2 = 99%], compared with those without NAFLD. After multivariable adjustment of confounding risk factors, NAFLD was still linked with a higher risk of HF incidence (random-effect HR = 1.36, 95% CI = 1.16–1.58, I2 = 98%). The risk of HF was increased not only in patients with progressive NAFLD severity but also in those with simple steatosis. The absolute risk difference of HF in NAFLD patients compared with those without NAFLD was 11.0 (95% CI = 4.9–17.7) per 10,000 person-years after multivariable adjustment. Conclusion: This meta-analysis suggests that NAFLD may be associated with an increased risk of incident HF. Owing to the high heterogeneity of the published studies, however, further high-quality studies are still needed.

Helicobacter pylori infection and risk of cardiovascular disease

“…The studies were graded as good quality (≥7 scores), fair quality (4–6 scores), and poor quality (<4 scores) 27 . Furthermore, we defined studies were with adequate adjustment, if the reported relative risks (RRs) were adjusted for at least five of the following seven risk factors (sex, age, antihypertensive treatment or hypertension, diabetes, smoking, body mass index or other measures of overweight/obesity and cholesterol) 28,29 …”

Non-alcoholic fatty liver disease and risk of cardiovascular diseases: clinical association, pathophysiological mechanisms, and management

“…(2022) [13] Ultrasound Meta-analysis (38 studies) (2022) [14] Ultrasound Meta-analysis (6 studies) [15] Ultrasound Meta-analysis (6 studies) (2018) [16] Ultrasound Systematic review and metaanalysis (12 studies) (2017) [17] Ultrasound Meta-analysis (3 studies) (2022) [18] Ultrasound Systematic review and metaanalysis (4 studies)…”

“…A meta-analysis of six studies involving 10,979,967 patients reported a higher risk of incident heart failure (HF) in subjects with NAFLD (adjusted HR: 1.36, 95% CI: 1.16–1.58) [14] . In a meta-analysis of six studies involving 12,374 HF patients, NAFLD was associated with higher risk of major composite adverse outcomes (i.e.…”

“…www.cardiologyplus.org Yang R and Fan J-G: Cardiology Plus (HF) in subjects with NAFLD (adjusted HR: 1.36, 95% CI: 1.16-1.58) [14] . In a meta-analysis of six studies involving 12,374 HF patients, NAFLD was associated with higher risk of major composite adverse outcomes (i.e.…”

Non-alcoholic fatty liver disease is associated with a worse prognosis in patients with heart failure: A pool analysis

“…NAFLD is considered to be one of the most common chronic liver diseases, as its prevalence is up to 25-45% in the general population ( 8 ). Recent studies suggested that NAFLD was associated with an increased risk of HF in patients, which may be caused by insulin resistance, impaired glucolipid metabolism, chronic inflammatory activation, increased renin-angiotensin-aldosterone and sympathetic nervous system activity, or the altered expression of adipokines and gut microbiota ( 9 , 10 ). Furthermore, the prevalence of NAFLD in HF patients is progressively increasing ( 11 – 13 ).…”