Risk of Cardiovascular Disease in Patients with Nonalcoholic Fatty Liver Disease

Targher, Giovanni; Day, Christopher P.; Bonora, Enzo

doi:10.1056/nejmra0912063

Cited by 1,711 publications

(1,502 citation statements)

References 70 publications

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“…These results expand previous reports in small cohorts of NAFLD patients [10][11][12][13], reporting a significant impairment in cardiac structure and function, as assessed by echocardiography or MRI, in clinically diagnosed NAFLD patients compared with subjects without fatty liver. Along this line, our results fit with the evidence for an association between liver injury and intima-media thickness [2], another early cardiovascular alteration, also present in NAFLD patients.…”

Section: Discussionsupporting

confidence: 90%

“…Second, the independent association between liver damage and both morphological and functional cardiac alterations might stem from the proinflammatory, proatherogenic and profibrogenic environment characterizing patients with NASH and/or advanced fibrosis. This inflammatory state might be able to act systemically, affecting the homeostasis of different organs, including the heart [2], as already demonstrated for systemic atherosclerosis and kidney damage [6,39].…”

Section: Discussionmentioning

confidence: 65%

“…In addition to an expected risk for disease progression from non-alcoholic steatohepatitis (NASH) to bridging fibrosis, cirrhosis and its complications [1], NAFLD patients are also at higher risk of early asymptomatic cardiovascular alterations and/or frank cardiovascular disease [2]. Specifically, NAFLD, diagnosed either by ultrasonography or by liver biopsy, has been associated with a higher prevalence of low coronary flow reserve [3], coronary calcification [4], and carotid atherosclerosis [5][6][7] well-before the occurrence of cardiovascular events.…”

Section: Introductionmentioning

confidence: 99%

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Epicardial fat, cardiac geometry and cardiac function in patients with non-alcoholic fatty liver disease: Association with the severity of liver disease

Petta

Argano

Colomba

et al. 2015

Journal of Hepatology

162

106

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Epicardial fat, cardiac geometry and cardiac function in patients with non-alcoholic fatty liver disease: Association with the severity of liver disease

Petta

Argano

Colomba

et al. 2015

Journal of Hepatology

162

106

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“…HFpEF and NAFLD may share other common pathophysiologies,1, 2, 45, 46, 47 namely elevated renin–angiotensin–aldosterone system, oxidative stress and inflammation, insulin resistance, impaired adiponectin, increased visceral fat, and increased systemic organ fibrosis associated with collagen turnover. Hence, NFS may suggest severity of pathophysiology of HFpEF, as well as NAFLD.…”

Section: Discussionmentioning

confidence: 99%

Liver fibrosis score predicts mortality in heart failure patients with preserved ejection fraction

et al. 2017

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AimsHeart failure with preserved ejection fraction (HFpEF) has several pathophysiological aspects, including stiffness and/or congestion of multiple organs. Poor prognosis is expected in heart failure patients with liver stiffness, which has recently been assessed by non‐alcoholic fatty liver disease fibrosis score (NFS; based on aspartate aminotransferase to alanine aminotransferase ratio, platelet counts, and albumin). We aimed to investigate the impact of NFS on prognosis of HFpEF patients, with consideration for the peripheral collagen markers such as procollagen type III peptide (PIIIP), type IV collagen 7S, and hyaluronic acid.Methods and resultsWe performed a prospective observational study. Consecutive 492 hospitalized HFpEF patients were divided into four groups based on their NFS: first–fourth quartiles (n = 123). The fourth quartile group had the highest levels of PIIIP, type IV collagen 7S, hyaluronic acid, and B‐type natriuretic peptide (P<0.001 each). In addition, there were significant positive correlations between PIIIP, type IV collagen 7S, hyaluronic acid, B‐type natriuretic peptide, and NFS (P < 0.001 each). In the follow‐up period (mean 1107 days), 93 deaths occurred. All‐cause mortality increased in all four quartiles (8.1%, 12.2%, 23.6%, and 31.7%, P < 0.001). In the multivariable Cox proportional hazard analysis, NFS was an independent predictor of all‐cause mortality in the HFpEF patients.ConclusionsNFS, a novel indicator of liver fibrosis, correlates with circulating systemic markers of fibrosis and congestion and is associated with higher all‐cause mortality in HFpEF patients. NFS can be calculated simply and may be a useful tool to assess liver stiffness and prognosis in HFpEF patients.

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“…NAFLD is commonly associated with components of metabolic syndrome2 and is an independent risk factor for cardiovascular disease 3, 4…”

Section: Introductionmentioning

confidence: 99%

Natural history of nonalcoholic fatty liver disease: A prospective follow‐up study with serial biopsies

Nasr

Ignatova

Kechagias

et al. 2017

Hepatology Communications

128

104

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Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in the world. The complete natural history of NAFLD is unknown because few high‐quality follow‐up studies have been conducted. Our aim was to find variables predicting disease severity through an extended follow‐up with serial biopsies. In a prospective cohort study, 129 patients who enrolled between 1988 and 1993 were asked to participate in a follow‐up study on two occasions; biochemical, clinical, and histologic data were documented. The mean time between biopsies was 13.7 (±1.7) and 9.3 (±1.0) years, respectively. At the end of the study period, 12 patients (9.3%) had developed end‐stage liver disease and 34% had advanced fibrosis. Out of the 113 patients with baseline low fibrosis (<3), 16% developed advanced fibrosis. Fibrosis progression did not differ among the different stages of baseline fibrosis (P = 0.374). Fifty‐six patients (43%) had isolated steatosis, of whom 9% developed advanced fibrosis (3 patients with biopsy‐proven fibrosis stage F3‐F4 and 2 patients with end‐stage liver disease). Fibrosis stage, ballooning, and diabetes were more common in patients who developed end‐stage liver disease; however, there were no baseline clinical, histologic, or biochemical variables that predicted clinical significant disease progression. Conclusion: NAFLD is a highly heterogeneous disease, and it is surprisingly hard to predict fibrosis progression. Given enough time, NAFLD seems to have a more dismal prognosis then previously reported, with 16% of patients with fibrosis stage <3 developing advanced fibrosis and 9.3% showing signs of end‐stage liver disease. (Hepatology Communications 2018;2:199–210)

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Risk of Cardiovascular Disease in Patients with Nonalcoholic Fatty Liver Disease

Cited by 1,711 publications

References 70 publications

Epicardial fat, cardiac geometry and cardiac function in patients with non-alcoholic fatty liver disease: Association with the severity of liver disease

Epicardial fat, cardiac geometry and cardiac function in patients with non-alcoholic fatty liver disease: Association with the severity of liver disease

Liver fibrosis score predicts mortality in heart failure patients with preserved ejection fraction

Natural history of nonalcoholic fatty liver disease: A prospective follow‐up study with serial biopsies

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