Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, Massachusetts.
Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, Massachusetts; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany.
Clin Gastroenterol Hepatol. 2021 Jul;19(7):1480-1488.e14. doi: 10.1016/j.cgh.2020.07.030. Epub 2020 Jul 21.
BACKGROUND & AIMS: Hepatic steatosis has been associated with increased risk of major adverse cardiovascular events (MACE) but it is not clear whether steatosis is independently associated with risk of MACE. We investigated whether steatosis is associated with risk of MACE independently of the presence and extent of baseline coronary artery disease, assessed by comprehensive contrast-enhanced computed tomography angiography (CTA).
We conducted a nested cohort study of 3756 subjects (mean age, 60.6 years; 48.4% men) who underwent coronary CTA at 193 sites in North America, from July 2010 through September 2013, as part of the PROMISE study, which included noninvasive cardiovascular analyses of symptomatic outpatients without coronary artery disease. Independent core laboratory readers measured hepatic and splenic attenuation, using non-contrast computed tomography images to identify steatosis, and evaluated coronary plaques and stenosis in coronary CTA images. We collected data on participants' cardiovascular risk factors, presence of metabolic syndrome, and body mass index. The primary endpoint was an adjudicated composite of MACE (death, myocardial infarction, or unstable angina) during a median follow-up time of 25 months.
Among the 959 subjects who had steatosis (25.5% of the cohort), 42 had MACE (4.4%), whereas among the 2797 subjects without steatosis, 73 had MACE (2.6%) (hazard ratio [HR] for MACE in subjects with steatosis, 1.69; 95% CI, 1.16-2.48; P = .006 for MACE in subjects with vs without steatosis). This association remained after adjustment for atherosclerotic cardiovascular disease risk scores, significant stenosis, and metabolic syndrome (adjusted HR, 1.72; 95% CI, 1.16-2.54; P = .007) or obesity (adjusted HR, 1.75; 95% CI, 1.19-2.59; P = .005). Steatosis remained independently associated with MACE after adjustment for all CTA measures of plaques and stenosis.
Hepatic steatosis is associated with MACE independently of other cardiovascular risk factors or extent of coronary artery disease. Strategies to reduce steatosis might reduce risk of MACE. ClinicalTrials.gov no: NCT01174550.
肝脂肪变性与主要不良心血管事件（MACE）的风险增加相关，但尚不清楚脂肪变性是否与 MACE 的风险独立相关。我们通过综合对比增强 CT 血管造影（CTA）评估的存在和程度来研究脂肪变性是否与 MACE 的风险独立相关。
我们进行了一项嵌套队列研究，纳入了 3756 名受试者（平均年龄 60.6 岁；48.4%为男性），他们于 2010 年 7 月至 2013 年 9 月在北美 193 个地点进行了冠状动脉 CTA，作为 PROMISE 研究的一部分，该研究包括无症状门诊患者的非侵入性心血管分析，这些患者没有冠状动脉疾病。独立的核心实验室读者使用非对比 CT 图像测量肝脏和脾脏的衰减，以确定脂肪变性，并评估冠状动脉 CTA 图像中的冠状动脉斑块和狭窄。我们收集了参与者的心血管危险因素、代谢综合征和体重指数的数据。主要终点是中位随访时间为 25 个月时确定的 MACE（死亡、心肌梗死或不稳定型心绞痛）复合终点。
在 959 名患有脂肪变性的受试者中（队列的 25.5%），有 42 人发生 MACE（4.4%），而在 2797 名没有脂肪变性的受试者中，有 73 人发生 MACE（2.6%）（脂肪变性患者的 MACE 风险比 [HR]，1.69；95%CI，1.16-2.48；P=0.006）。在调整了动脉粥样硬化性心血管疾病风险评分、显著狭窄和代谢综合征（调整后的 HR，1.72；95%CI，1.16-2.54；P=0.007）或肥胖（调整后的 HR，1.75；95%CI，1.19-2.59；P=0.005）后，这种关联仍然存在。在调整所有 CTA 斑块和狭窄测量值后，脂肪变性仍与 MACE 独立相关。
肝脂肪变性与 MACE 独立相关，与其他心血管危险因素或冠状动脉疾病的严重程度无关。减少脂肪变性的策略可能会降低 MACE 的风险。临床试验.gov 注册号：NCT01174550。
