Hepatic steatosis and advanced fibrosis are independent predictors of mortality in acute myocardial infarction without standard modifiable risk factors

Chew, Nicholas; Figtree, Gemma A.; Kong, Gwyneth; Vernon, Steve; Muthiah, Mark; Ng, Cheng Han; Chan, Mark Y; Loh, Poay Huan

doi:10.1111/dom.14820

Cited by 13 publications

(11 citation statements)

References 18 publications

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“…Subgroup survival analysis was performed based on AMI type and the absence of standard modifiable cardiovascular risk factors (defined in this study as active smoking, hypertension, hyperlipidaemia and/or diabetes). 15,21,35,36 A P value of .05 or less was considered statistically significant. The study was approved by the local institutional review committee in accordance with the revised Declaration of Helsinki (NHG Research-DSRB: 2021/00089-AMD0001).…”

Section: Discussionmentioning

confidence: 99%

“…34 Long-term mortality was collected from the mortality database that is accessible via the national integrated health information systems. 15,[19][20][21]23 The Kaplan-Meier survival curves for all-cause mortality were constructed and stratified according to hepatic steatosis and advanced hepatic fibrosis status.…”

Section: Study Outcomesmentioning

confidence: 99%

“…However, the prognostic significance of hepatic steatosis and advanced hepatic fibrosis following AMI has not been established. 15 Given the inflammatory and pro-atheromatous metabolic milieu associated with NAFLD, we hypothesized that hepatic steatosis is prevalent among patients with AMI and is associated with a poorer prognosis compared with those without steatosis.…”

Section: Introductionmentioning

confidence: 99%

“…Interest in understanding the NAFLD and CVD interface has grown in recent years, but most studies have only described the increased incidence in cardiovascular diseases, 2,8 metabolic burden 12,13 and cardiovascular mortality 6,14 in the general population with hepatic steatosis. However, the prognostic significance of hepatic steatosis and advanced hepatic fibrosis following AMI has not been established 15 . Given the inflammatory and pro‐atheromatous metabolic milieu associated with NAFLD, we hypothesized that hepatic steatosis is prevalent among patients with AMI and is associated with a poorer prognosis compared with those without steatosis.…”

Section: Introductionmentioning

confidence: 99%

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Hepatic steatosis and advanced hepatic fibrosis are independent predictors of long‐term mortality in acute myocardial infarction

Chin

Lim

Kong

et al. 2023

Diabetes Obesity Metabolism

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Aim To examine the prevalence and prognosis of hepatic steatosis and fibrosis in post‐acute myocardial infarction (AMI) patients. Methods Patients presenting with AMI to a tertiary hospital were examined from 2014 to 2021. Hepatic steatosis and advanced hepatic fibrosis were determined using the Hepatic Steatosis Index and fibrosis‐4 index, respectively. The primary outcome was all‐cause mortality. Cox regression models identified determinants of mortality after adjustments and Kaplan–Meier curves were constructed for all‐cause mortality, stratified by hepatic steatosis and advanced fibrosis. Results Of 5765 patients included, 24.8% had hepatic steatosis, of whom 41.7% were diagnosed with advanced fibrosis. The median follow‐up duration was 2.7 years. Patients with hepatic steatosis tended to be younger, female, with elevated body mass index and an increased metabolic burden of diabetes, hypertension and hyperlipidaemia. Patients with hepatic steatosis (24.6% vs. 20.9% mortality, P < .001) and advanced fibrosis (45.6% vs. 32.9% mortality, P < .001) had higher all‐cause mortality rates compared with their respective counterparts. Hepatic steatosis (adjusted hazard ratio 1.364, 95% CI 1.145‐1.625, P = .001) was associated with all‐cause mortality after adjustment for confounders. Survival curves showed excess mortality in patients with hepatic steatosis compared with those without (P = .002). Conclusions Hepatic steatosis and advanced fibrosis have a substantial prevalence among patients with AMI. Both are associated with mortality, with an incrementally higher risk when advanced fibrosis ensues. Hepatic steatosis and fibrosis could help risk stratification of AMI patients beyond conventional risk factors.

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Section: Discussionmentioning

confidence: 99%

Section: Study Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hepatic steatosis and advanced hepatic fibrosis are independent predictors of long‐term mortality in acute myocardial infarction

Chin

Lim

Kong

et al. 2023

Diabetes Obesity Metabolism

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“…In addition, obesity is also linked with higher levels of inflammatory markers, insulin resistance, fatty liver, and visceral adiposity; hence, individuals with obesity are at higher risk of concomitant type 2 diabetes and nonalcoholic fatty liver disease. These associated metabolic risk factors have been described to be independent predictors of mortality [30][31][32]. The use of pharmacological therapy also possesses cardioprotective properties that can modulate the cardiovascular risk of individuals.…”

Section: Discussionmentioning

confidence: 99%

A two‐decade population‐based study on the effect of hypertension in the general population with obesity in the United States

Kong

Chin

Lim

et al. 2023

Obesity

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Objective: With rising prevalence of hypertension and obesity, the effect of hypertension in obesity remains an important global issue. The prognosis of the US general population with obesity based on hypertension control was examined.Methods: This study examined participants from the National Health and Nutrition Examination Survey between 1999 and 2018. Individuals with obesity were stratified into no hypertension, controlled hypertension, and uncontrolled hypertension. The study outcome was all-cause mortality. Cox regression of all-cause mortality was adjusted for age, sex, ethnicity, diabetes, and previous myocardial infarction.Results: Of 16,386 individuals with obesity, 53.1% had no hypertension, 24.7% had controlled hypertension, and 22.2% had uncontrolled hypertension. All-cause mortality was significantly higher in uncontrolled hypertension (17.1%), followed by controlled hypertension (14.8%) and no hypertension (4.0%). Uncontrolled hypertension had the highest mortality risk (hazard ratio [HR] 1.34, 95% CI: 1.13-1.59, p = 0.001),

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Sex differences in survival following acute coronary syndrome with and without standard modifiable risk factors

Anand,

Koh,

Teo

et al. 2024

Clin Res Cardiol

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Hepatic steatosis and advanced fibrosis are independent predictors of mortality in acute myocardial infarction without standard modifiable risk factors

Cited by 13 publications

References 18 publications

Hepatic steatosis and advanced hepatic fibrosis are independent predictors of long‐term mortality in acute myocardial infarction

Hepatic steatosis and advanced hepatic fibrosis are independent predictors of long‐term mortality in acute myocardial infarction

A two‐decade population‐based study on the effect of hypertension in the general population with obesity in the United States

Sex differences in survival following acute coronary syndrome with and without standard modifiable risk factors

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