Systematic review and meta‐analysis: Association between liver fibrosis and subclinical atherosclerosis in nonalcoholic fatty liver disease

Jamalinia, Mohamad; Zare, Fatemeh; Lankarani, Kamran B.

doi:10.1111/apt.17617

Cited by 17 publications

(5 citation statements)

References 31 publications

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“…Liver fibrosis has been proposed as an independent risk factor for subclinical atherosclerosis, possibly due to its role in subclinical inflammation and oxidative stress [ 17 ]. In a meta-analysis of 12 studies of NAFLD patients, the OR for the association between liver fibrosis and subclinical atherosclerosis was 2.18 (95% CI 1.62–2.93), and in the subgroup analysis, the OR for the association with CAC was 2.76 (95% CI 1.18–6.45) [ 29 ]. Those findings are in line with our finding that SLD patients with more severe liver fibrosis had more rapid advances in coronary atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

Steatotic liver disease and its newly proposed sub-classifications correlate with progression of the coronary artery calcium score

Kim,

Kang,

Choi

et al. 2024

PLoS ONE

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Background & aims A new nomenclature, Steatotic Liver Disease (SLD), has been proposed by consensus with sub-classifications and requires evidence-based validation. We assessed whether the presence and severity of SLD, as well as its sub-classifications, are associated with the progression of coronary atherosclerosis. Methods This longitudinal cohort study included 13,811 adults who participated in repeated regular health screening examinations between January 1, 2004 and December 31, 2021 that included assessments of their coronary artery calcium (CAC) scores. SLD was defined using abdominal ultrasonography and classified as metabolic dysfunction associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and cryptogenic SLD. SLD severity was assessed using fibrosis-4 (FIB-4) scores. The progression of CAC scores was measured using multidetector CT scans. Results The average duration of follow-up was 5.8 years. During follow-up, the annual rate of CAC progression in participants with and without SLD was 18% (95% CI 17%–19%) and 14% (95% CI 13%–14%) (p < 0.01), respectively. The multivariable ratios of progression rates when we compared participants with cryptogenic SLD, MASLD, or MetALD with those without SLD were 0.98 (95% CI 0.95–1.01), 1.03 (95% CI 1.03–1.04), and 1.07 (95% CI 1.04–1.09), respectively. The multivariable ratios of progression rates when we compared participants with SLD with FIB-4 score <1.3 and SLD with FIB-4 score ≥1.3 with those without SLD were 1.03 (95% CI 1.02–1.04), and 1.05 (95% CI 1.04–1.06), respectively. Conclusions SLD was associated with a higher risk of coronary atherosclerosis, and the risk differed by sub-classifications and severity. These findings suggest that the newly proposed definition has clinical relevance in terms of stratifying cardiovascular disease risk.

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Section: Discussionmentioning

confidence: 99%

Steatotic liver disease and its newly proposed sub-classifications correlate with progression of the coronary artery calcium score

Kim,

Kang,

Choi

et al. 2024

PLoS ONE

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“…60 In particular, the association of LF in NAFLD with subclinical atherosclerosis was shown, and LF severity aggravated this relationship. 29 Coronary artery calcium scoring via computerized tomography is usually used to determine the degree of coronary atherosclerosis. In a study involving 665 NAFLD patients, noninvasive LF markers, such as APRI index, NFS, and FIB-4 score, made it possible to reliably predict the values of the coronary calcium index >100 via computerized tomography.…”

Section: Subclinical Coronary Atherosclerosismentioning

confidence: 99%

Liver Fibrosis as an Independent Cardiovascular Risk Factor in Non-alcoholic Fatty Liver Disease

Garbuzenko

2024

J Transl Gastroenterol

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This review summarizes the current investigations that confirm the significance of liver fibrosis (LF) as an independent cardiovascular risk factor in non-alcoholic fatty liver disease (NAFLD). PubMed, Google Scholar, Web of Science platform, Reference Citation Analysis, and Cochrane Systematic Reviews were searched for articles published between 2008 and 2023. Relevant articles were identified using the following keywords: "cardiovascular diseases", "cardiovascular risk factors", "non-alcoholic fatty liver disease", "nonalcoholic steatohepatitis", and "liver fibrosis". The reference lists of the identified articles were also searched for other relevant publications. The investigations that described LF as a cardiovascular risk factor in NAFLD met the inclusion criteria. NAFLD occupies a leading position among liver diseases worldwide. Cardiovascular disorders are the most significant cause of unfavorable outcomes in NAFLD patients. Currently, the relationship between them is well established. The pathophysiological mechanisms predisposing to the development of cardiovascular disorders in NAFLD include atherogenic dyslipidemia, impaired glucose metabolism and liver insulin resistance, low-grade systemic inflammation, endothelial dysfunction, cardiovascular remodeling, as well as gut dysbiosis, which are influenced by numerous genetic and epigenetic factors. Identification of cardiovascular risk factors in NAFLD is an important public health issue. At present, there is evidence that the presence of advanced LF may be a strong independent predictor and risk factor for cardiovascular disorders in NAFLD. It is obvious that early diagnosis of LF will allow to stratify NAFLD patients by cardiovascular risk groups and thereby determine the most optimal therapeutic interventions.

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“…Both conditions independently contribute to adverse health outcomes, and their simultaneous presence further amplifies the risk of cardiovascular events, liver-related complications, and overall mortality in individuals with NAFLD. Therefore, understanding and addressing this intricate relationship can profoundly impact patient prognosis [56].…”

Section: Clinical Implications and Prognostic Significancementioning

confidence: 99%

Uncovering the Cardiovascular Threat: A Comprehensive Examination of Liver Fibrosis and Subclinical Atherosclerosis in Non-alcoholic Fatty Liver Disease

Sharma,

Chakole,

Wandile

2023

Cureus

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Non-alcoholic fatty liver disease (NAFLD) has emerged as a global epidemic intricately linked to the rising tide of obesity and metabolic syndrome. This comprehensive review delves into the complex web of relationships between NAFLD, liver fibrosis, and subclinical atherosclerosis, shedding light on their interplay, shared risk factors, and clinical implications. NAFLD encompasses a spectrum of liver conditions, from the benign non-alcoholic fatty liver (NAFL) to the more severe non-alcoholic steatohepatitis (NASH), characterized by inflammation and hepatocellular injury. Central to the discussion is the insidious development of liver fibrosis, the ominous harbinger of progressive liver damage, cirrhosis, and hepatocellular carcinoma. The increasing prevalence of NAFLD, now affecting a quarter of the global population, poses a significant public health challenge. Its association with obesity, insulin resistance, and metabolic syndrome highlights the multifactorial nature of this disease. However, NAFLD's repercussions extend beyond the liver. This review unveils a potent connection between NAFLD and subclinical atherosclerosis, the early precursor to cardiovascular disease. Individuals with NAFLD face an elevated risk of atherosclerosis, even without traditional cardiovascular risk factors. The intricate link between these two conditions is illuminated through shared pathophysiological pathways, including systemic inflammation, insulin resistance, and dyslipidemia. Understanding the interplay between liver fibrosis and subclinical atherosclerosis has profound clinical implications. Patients with advanced fibrosis or cirrhosis are not only at risk of liver-related complications but also of cardiovascular events. This necessitates a holistic approach to patient care, with lifestyle modifications and pharmacological interventions simultaneously managing both conditions. Physicians must prioritize early detection and collaborate across disciplines to provide comprehensive care. Looking ahead, the future holds promising avenues of research. Emerging areas include genetics and precision medicine, microbiome research, and epigenetics, which may unveil new therapeutic targets. Innovations in diagnostics and therapeutics, such as non-invasive biomarkers and combination therapies, offer hope for more effective management. Long-term outcomes and survivorship research will provide insights into the lasting impact of interventions.In conclusion, this review underscores the imperative of addressing liver fibrosis and atherosclerosis in the context of NAFLD. It is a call to action for healthcare professionals, researchers, and policymakers to work collaboratively, promote early detection, and advance our understanding of these interconnected conditions. By doing so, we can enhance patient outcomes and chart a course toward a healthier future for those grappling with NAFLD and its intricate web of consequences.

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Systematic review and meta‐analysis: Association between liver fibrosis and subclinical atherosclerosis in nonalcoholic fatty liver disease

Cited by 17 publications

References 31 publications

Steatotic liver disease and its newly proposed sub-classifications correlate with progression of the coronary artery calcium score

Steatotic liver disease and its newly proposed sub-classifications correlate with progression of the coronary artery calcium score

Liver Fibrosis as an Independent Cardiovascular Risk Factor in Non-alcoholic Fatty Liver Disease

Uncovering the Cardiovascular Threat: A Comprehensive Examination of Liver Fibrosis and Subclinical Atherosclerosis in Non-alcoholic Fatty Liver Disease

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