Author information
1Department of Gastroenterology and Hepatology, Alfred Health, Ground Floor Alfred Centre 55 Commercial Road, VIC 3004, Melbourne, Australia. k.vaz@alfred.org.au.
2Central Clinical School, Monash University, Melbourne, Australia. k.vaz@alfred.org.au.
3Department of Gastroenterology and Hepatology, Alfred Health, Ground Floor Alfred Centre 55 Commercial Road, VIC 3004, Melbourne, Australia.
4Central Clinical School, Monash University, Melbourne, Australia.
5Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia.
6Department of Rural Health, University of Melbourne, Melbourne, Australia.
7Macarthur Clinical School, School of Medicine, Western Sydney University, Penrith, Australia.
#Contributed equally.
Abstract
Background and aims: The association between fatty liver disease (FLD) and cardiovascular disease (CVD) in an Australian context has yet to be defined. The primary aim of this study was to investigate the association between FLD and 3-point major adverse cardiovascular events (MACE).
Methods: This was a longitudinal follow-up study of a randomly sampled adult cohort from regional Australia between 2001 and 2003. Baseline covariates included demographic details, anthropometry, health and lifestyle data, and laboratory tests. Non-alcoholic fatty liver disease (NAFLD) and metabolic-(dysfunction) associated fatty liver disease (MAFLD) were diagnosed in participants with fatty liver index (FLI) ≥ 60 and meeting other standard criteria. ICD-10 codes were used to define clinical outcomes linked to hospitalisations. Three-point MACE defined as non-fatal myocardial infarction (MI) and cerebrovascular accident (CVA) and CVD death.
Results: In total, 1324 and 1444 participants met inclusion criteria for NAFLD and MAFLD analysis, respectively. Over 23,577 and 25,469 person-years follow-up, NAFLD and MAFLD were independent predictors for 3-point MACE, adjusting for demographic covariates and known cardiometabolic risk factors, whilst considering non-CVD death as a competing event (NAFLD: sub-hazard ratio [sHR] 1.56, 95% confidence interval [CI 1.12-2.19]; MAFLD: sHR 1.51, 95% CI 1.11-2.06). The results held true on several sensitivity analyses.
Conclusions: Both forms of FLD increase the risk for CVD independent of traditional cardiometabolic risk factors.