Fatty liver index and development of cardiovascular disease in Koreans without pre-existing myocardial infarction and ischemic stroke: a large population-based study

Abstract

Background: Despite the known association between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD), whether NAFLD predicts future CVD events, especially CVD mortality, remains uncertain. We evaluated the relationship between fatty liver index (FLI), a validated marker of NAFLD, and risk of major adverse cardiac events (MACEs) in a large population-based study. Methods: We identified 3011,588 subjects in the Korean National Health Insurance System cohort without a history of CVD who underwent health examinations from 2009 to 2011. The primary endpoint was a composite of cardiovascular deaths, non-fatal myocardial infarction (MI), and ischemic stroke. A Cox proportional hazards regression analysis was performed to assess association between the FLI and the primary endpoint. Results: During the median follow-up period of 6 years, there were 46,010 cases of MACEs (7148 cases of cardiovascular death, 16,574 of non-fatal MI, and 22,288 of ischemic stroke). There was a linear association between higher FLI values and higher incidence of the primary endpoint. In the multivariable models adjusted for factors, such as body weight and cholesterol levels, the hazard ratio for the primary endpoint comparing the highest vs. lowest quartiles of the FLI was 1.99 (95% confidence interval [CIs], 1.91-2.07). The corresponding hazard ratios (95% CIs) for cardiovascular death, non-fetal MI, and ischemic stroke were 1.98 (1.9-2.06), 2.16 (2.01-2.31), and 2.01 (1.90-2.13), respectively (p < 0.001). The results were similar when we performed stratified analyses by age, sex, use of dyslipidemia medication, obesity, diabetes, and hypertension.

Prognostic value of non-alcoholic fatty liver disease for predicting cardiovascular events in patients with diabetes mellitus with suspected coronary artery disease: a prospective cohort study

“…The presence of systemic inflammation promoted by cytokines secreted from the liver leads to endothelial dysfunction, altering vascular tone and enhancing vascular plaque formation. This mechanism was supported by a clinical study that found a significant association between the severity of NAFLD and both surrogate markers of atherosclerosis and an increased risk of cardiovascular mortality in NAFLD patients [25][26][27][28].…”

Empagliflozin Attenuates Non-Alcoholic Fatty Liver Disease (NAFLD) in High Fat Diet Fed ApoE(-/-) Mice by Activating Autophagy and Reducing ER Stress and Apoptosis

“…Notably, the strong bidirectional relationship between NAFLD and CVD is well established. Indeed, Kim et al recently showed that NAFLD has prognostic value for identifying individuals who are at higher risk for CVD [ 69 ].…”

Acute Coronary Syndromes and Nonalcoholic Fatty Liver Disease: “Un Affaire de Coeur”

“…(2) opinion [27]; (3) manuscripts in Chinese and Russian languages [28,29]; (4) article evaluating the differential expression genes of NAFLD and in acute myocardial infarction datasets [30]; and (5) an article published under hepatology elsewhere section where the full article is already included in our systematic review [31]. Hence, a total of 14 records fulfilled our inclusion and exclusion criteria and were included in our qualitative assessment and systematic review as described in Figure 1 [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48].…”

“…Six studies had a cohort study design (retrospective cohort study [35,46], prospective cohort study [36,37], prospective population-based cohort study [41], matched cohort study [42], nationwide population-based cohort study [43], and cohort study [44,47]). Moreover, two studies had a cross-sectional study design (cross-sectional study [32] and cross-sectional analysis of a prospective single-center study [45]) and two observational studies (retrospective observational study [34,40]).…”

“…We used the NHLBI quality assessment tools to evaluate the methodological quality of eligible studies included in the qualitative assessment and systematic review as demonstrated in Table 2. Seven studies had an overall rating of "good" [33,34,36,[41][42][43][44], eight studies were rated "fair" [32,35,37,39,40,45,46,48], and two studies were rated "poor" [38,47]. Generally, all included studies clearly stated a research question or objective.…”