Cardiovascular Risk Categories in Patients With Nonalcoholic Fatty Liver Disease and the Role of Low‐Density Lipoprotein Cholesterol

Abstract

Cardiovascular disease (CVD) is the leading cause of death in patients with nonalcoholic fatty liver disease (NAFLD). The current analysis expands the knowledge on atherogenic lipid profiles in NAFLD by modeling changes in low‐density lipoprotein cholesterol (LDL‐C) and total cholesterol (TC) in a prospectively enrolling real‐life study cohort to inform physicians on the cardiovascular (CV) event risk based on these changes. A total of 304 patients with histologically confirmed NAFLD were included (mean age, 52 years; equal sex distribution). Of these, 129 (42.4%) patients exhibited a NAFLD activity score ≥4 and 186 (61.2%) had at least intermediate fibrosis ≥F2. The median TC levels were 209 mg/dL (interquartile range [IQR], 183, 239), LDL‐C 131 mg/dL (IQR, 103, 152), and high‐density lipoprotein cholesterol (HDL‐C) 45 mg/dL (IQR, 38, 52). Only 16.9% of patients received lipid‐lowering therapy. According to the LDL/HDL ratio, 69 (23.7%) patients exhibited a high CV risk. The 10‐year CV event risk according to the Framingham risk score (FRS) was low in 91 (41.2%), intermediate in 59 (26.7%), and high in 71 (32.1%) patients and higher in the ≥F2 NAFLD population. A moderate increase in LDL‐C levels by 20 mg/dL led to a transition of 20% of patients into the high‐risk group when assessing the LDL/HDL ratio. According to the FRS, 6 (2.7%) patients moved from low to intermediate and 11 (4.9%) from intermediate to high CV risk. Conclusion: Patients with NAFLD exhibit a substantial CV event risk and are frequently undertreated with lipid‐lowering medication. Moderate increases in LDL‐C would result in worsening of the CV event risk in approximately 7.8% of all patients without a history of CVD.

Adipokines and Endotoxemia Correlate with Hepatic Steatosis in Non-Alcoholic Fatty Liver Disease (NAFLD)

“…Metabolic inflammation is an emerging concept in patients with NAFLD to describe their multimorbidity. From a clinical perspective patients with NAFLD exhibit a significantly increased cardiovascular event risk [29], with NAFLD being an independent risk factor for non-fatal coronary heart disease and all-cause mortality with a hazard ratio (HR) of 1.43 after adjustment for traditional risk factors [30]. Animal models support the role of the hepatic compartment as one source of hepatic immune cell activation that links the liver to adipose tissue dysfunction [31].…”

Nonalcoholic Fatty Liver Disease Increases the Risk of Anxiety and Depression

“…However, there are several lines of data that link NAFLD to impaired health-related quality of life and cardiovascular diseases. (26,27) Thus, NAFLD could be an important indicator of comorbidities for which effective management and treatment are available. Beyond this, medical therapies for patients with NAFLD and advanced fibrosis can be expected in 2020, and identification to initiate treatment will have beneficial effects on mortality in these patients.…”

Emerging Pharmacological Treatment in Nonalcoholic Steatohepatitis

“…Safety concerns occurred with pruritus being reported in up to 50% of the 25-mg treatment group, and LDL levels were increased. However, these results have to be put into perspective, as most patients with NASH exhibited a heightened cardiovascular risk event, and when modeling the safety profile observed in the RE-GENERATE trials, only 8% of all patients showed changes with respect to the risk of a cardiovascular event [16].…”