Division of Gastroenterology and Hepatology, Hunter-Holmes McGuire Veterans Affairs Medical Center, Virginia Commonwealth University, Richmond, VA, 23249, USA.
Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, USA.
Dig Dis Sci. 2021 Jan;66(1):263-272. doi: 10.1007/s10620-020-06196-4. Epub 2020 Mar 18.
The prevalence of coronary artery disease (CAD) is high among patients with cirrhosis; however, the impact of it on cardiovascular disease (CVD) is not known. The aim of the current study was to evaluate CVD events in patients with cirrhosis and impact of cirrhosis on biomarkers of atherogenesis.
The study included 682 patients with decompensated cirrhosis referred for liver transplantation (LT) evaluation between 2010 and 2017. All patients were followed until they experienced a CVD event, non-cardiac death, liver transplantation or last follow-up. To evaluate mechanistic link, patients with NASH cirrhosis were propensity matched 1:2 to non-cirrhosis NASH patients and biomarkers of atherogenic risk were compared.
The composite CVD outcome occurred in 23(3.4%) patients after a median follow-up period of 585 days (IQR 139, 747). A strong association between presence of any CAD and CVD event was noted (HR = 6.8, 95% CI 2.9, 15.9) that was independent of age, gender, BMI, and MELD score. In competing risk model, the combined rate of LT and non-cardiac was significantly higher when compared to the rate of CVD events. Marker of insulin resistance and inflammation-related markers were similar in patients with and without cirrhosis. Patients with cirrhosis were more likely to have reduced VLDL, sdLDL-C, LDL-C, and triglycerides. Interestingly, patients with cirrhosis had an increase in serum HDL-2, the anti-atherogenic lipoprotein, and adiponectin, a protective serum adipokine.
The risk of CVD events in patients with cirrhosis is low and may potentially be due to improvement in markers of atherogenic risk.
冠心病（CAD）在肝硬化患者中较为常见；然而，其对心血管疾病（CVD）的影响尚不清楚。本研究旨在评估肝硬化患者的 CVD 事件，并评估肝硬化对动脉粥样形成生物标志物的影响。
本研究纳入了 2010 年至 2017 年间因肝移植（LT）评估而就诊的 682 例失代偿性肝硬化患者。所有患者均随访至发生 CVD 事件、非心脏性死亡、LT 或最后一次随访。为了评估机制联系，将 NASH 肝硬化患者按 1:2 与非肝硬化 NASH 患者进行倾向匹配，并比较了动脉粥样形成风险的生物标志物。
在中位随访 585 天（IQR 139，747）后，23 例（3.4%）患者发生复合 CVD 结局。存在任何 CAD 与 CVD 事件之间存在强烈关联（HR=6.8，95%CI 2.9，15.9），与年龄、性别、BMI 和 MELD 评分无关。在竞争风险模型中，与 CVD 事件相比，LT 和非心脏性死亡的联合发生率明显更高。肝硬化患者的胰岛素抵抗和炎症相关标志物与无肝硬化患者相似。肝硬化患者的 VLDL、sdLDL-C、LDL-C 和甘油三酯水平降低。有趣的是，肝硬化患者血清 HDL-2（抗动脉粥样形成脂蛋白）和脂联素（一种保护性血清脂肪因子）增加。
肝硬化患者发生 CVD 事件的风险较低，这可能是由于动脉粥样形成风险标志物的改善。
