Niederseer David, Wernly Sarah, Bachmayer Sebastian, Wernly Bernhard, Bakula Adam, Huber-Schönauer Ursula, Semmler Georg, Schmied Christian, Aigner Elmar, Datz Christian
Department of Cardiology, University Heart Center Zurich, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland.
Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5110 Oberndorf, Austria.
J Clin Med. 2020 Apr 9;9(4):1065. doi: 10.3390/jcm9041065.
Many patients with non-alcoholic fatty liver disease (NAFLD) simultaneously suffer from cardiovascular (CV) disease and often carry multiple CV risk factors. Several CV risk factors are known to drive the progression of fibrosis in patients with NAFLD.
To investigate whether an established CV risk score, the Framingham risk score (FRS), is associated with the diagnosis of NAFLD and the degree of fibrosis in an Austrian screening cohort for colorectal cancer.
In total, 1965 asymptomatic subjects (59 ± 10 years, 52% females, BMI 27.2 ± 4.9 kg/m) were included in this study. The diagnosis of NAFLD was present if (1) significantly increased echogenicity in relation to the renal parenchyma was present in ultrasound and (2) viral, autoimmune or hereditary liver disease and excess alcohol consumption were excluded. The FRS (ten-year risk of coronary heart disease) and NAFLD Fibrosis Score (NFS) were calculated for all patients. High CV risk was defined as the highest FRS quartile (>10%). Both univariable and multivariable logistic regression models were used to calculate associations of FRS with NAFLD and NFS.
Compared to patients without NAFLD ( = 990), patients with NAFLD ( = 975) were older (60 ± 9 vs. 58 ± 10 years; < 0.001), had higher BMI (29.6 ± 4.9 vs. 24.9 ± 3.6 kg/m; < 0.001) and suffered from metabolic syndrome more frequently (33% vs. 7%; < 0.001). Cardiovascular risk as assessed by FRS was higher in the NAFLD-group (8.7 ± 6.4 vs. 5.4 ± 5.2%; < 0.001). A one-percentage-point increase of FRS was independently associated with NAFLD (OR 1.04, 95%CI 1.02-1.07; < 0.001) after correction for relevant confounders in multivariable logistic regression. In patients with NAFLD, NFS correlated with FRS ( = 0.29; < 0.001), and FRS was highest in patients with significant fibrosis (F3-4; 11.7 ± 5.4) compared to patients with intermediate results (10.9 ± 6.3) and those in which advanced fibrosis could be ruled-out (F0-2, 7.8 ± 5.9, < 0.001). A one-point-increase of NFS was an independent predictor of high-risk FRS after correction for sex, age, and concomitant diagnosis of metabolic syndrome (OR 1.30, 95%CI 1.09-1.54; = 0.003).
The presence of NAFLD might independently improve prediction of long-term risk for CV disease and the diagnosis of NAFLD might be a clinically relevant piece in the puzzle of predicting long-term CV outcomes. Due to the significant overlap of advanced NAFLD and high CV risk, aggressive treatment of established CV risk factors could improve prognosis in these patients.
许多非酒精性脂肪性肝病（NAFLD）患者同时患有心血管（CV）疾病，且常伴有多种CV危险因素。已知多种CV危险因素会促使NAFLD患者的纤维化进展。
在奥地利一个结直肠癌筛查队列中，研究一种既定的CV风险评分——弗雷明汉风险评分（FRS）是否与NAFLD的诊断及纤维化程度相关。
本研究共纳入1965名无症状受试者（年龄59±10岁，女性占52%，体重指数27.2±4.9kg/m²）。若满足以下条件，则诊断为NAFLD：（1）超声检查显示相对于肾实质回声显著增强；（2）排除病毒性、自身免疫性或遗传性肝病以及过量饮酒。计算所有患者的FRS（冠心病十年风险）和NAFLD纤维化评分（NFS）。高CV风险定义为FRS最高四分位数（>10%）。采用单变量和多变量逻辑回归模型计算FRS与NAFLD及NFS的关联。
与无NAFLD的患者（n = 990）相比，NAFLD患者（n = 975）年龄更大（60±9岁 vs. 58±10岁；P<0.001），体重指数更高（29.6±4.9kg/m² vs. 24.9±3.6kg/m²；P<0.001），更频繁地患有代谢综合征（33% vs. 7%；P<0.001）。NAFLD组经FRS评估的心血管风险更高（8.7±6.4% vs. 5.4±5.2%；P<0.001）。在多变量逻辑回归中校正相关混杂因素后，FRS每增加一个百分点与NAFLD独立相关（比值比1.04，95%置信区间1.02 - 1.07；P<0.0
