Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. This work was partially supported by the Capital Health Development Fund (grant number 201614035) and CAMS Major Collaborative Innovation Project (grant number 2016-I2M-1-011) awarded to J.-J.L.
Clin Transl Gastroenterol. 2019 Feb;10(2):e00011. doi: 10.14309/ctg.0000000000000011.
Whether non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular risk has still been controversial. The reasons for this disparity may be associated with subject selection, events definition, diagnostic criteria of NAFLD, or research methods. The aim of this study was to determine the relationship of NAFLD to cardiovascular disease (CVD) outcomes in patients with stable, new-onset coronary artery disease (CAD).
A matched case-control study based on the cohort with stable, new-onset CAD was implemented in 162 cases (patients who developed all-cause death, non-fatal myocardial infarction and stroke during an average of 11,484 patient-years of follow-up) and 162 controls without cardiovascular events matched with the same sex, the age difference ≤3 years old, and the admission date within 3 months. Abdominal ultrasonography and coronary angiography were performed at admission. COX proportional hazard models and conditional logistic regression analysis were used to assess the effect of NAFLD on CVD outcomes.
NAFLD was more common in the event group than in the control group (P = 0.012). Kaplan-Meier analysis showed a significant association between NAFLD and CVD outcomes (P = 0.007). Moreover, Cox regression (hazard ratios 1.56; 95% confidence interval, 1.04-2.34, P = 0.031) and conditional logistic regression (odds ratio 2.72, 95% confidence interval, 1.16-6.39, P = 0.022) analyses further demonstrated that NAFLD was an independent risk factor for CVD outcomes.
NAFLD is indeed an independent predictor of CVD outcomes in patients with stable, new-onset CAD. Further randomized controlled trials may be needed to confirm our findings.
非酒精性脂肪性肝病（NAFLD）是否与心血管风险相关仍存在争议。造成这种差异的原因可能与研究对象的选择、事件定义、NAFLD 的诊断标准或研究方法有关。本研究旨在确定稳定新发冠状动脉疾病（CAD）患者中 NAFLD 与心血管疾病（CVD）结局的关系。
基于稳定新发 CAD 的队列，进行了一项匹配病例对照研究。纳入了 162 例患者（在平均 11484 患者年的随访期间发生全因死亡、非致死性心肌梗死和中风的患者）和 162 例无心血管事件的对照，匹配性别、年龄差≤3 岁、入院日期在 3 个月内。入院时行腹部超声和冠状动脉造影。采用 COX 比例风险模型和条件逻辑回归分析评估 NAFLD 对 CVD 结局的影响。
事件组中 NAFLD 的发生率高于对照组（P=0.012）。Kaplan-Meier 分析显示，NAFLD 与 CVD 结局之间存在显著相关性（P=0.007）。此外，Cox 回归（风险比 1.56；95%置信区间，1.04-2.34，P=0.031）和条件逻辑回归（比值比 2.72，95%置信区间，1.16-6.39，P=0.022）分析进一步表明，NAFLD 是 CVD 结局的独立危险因素。
NAFLD 确实是稳定新发 CAD 患者 CVD 结局的独立预测因素。可能需要进一步的随机对照试验来证实我们的发现。
