I Clinica Medica, Atherothrombosis Centre, Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy.
Intern Emerg Med. 2021 Nov;16(8):2063-2068. doi: 10.1007/s11739-021-02682-3. Epub 2021 Mar 13.
Whether non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular events (CVEs) independently from metabolic syndrome (MetS) is still matter of debate. Aim of the study was to investigate the risk of CVEs in a high-risk population of patients with non-valvular atrial fibrillation (AF) according to the presence of MetS and NAFLD. Prospective observational multicenter study including 1,735 patients with non-valvular AF treated with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). NAFLD was defined by a fatty liver index ≥ 60. We categorized patients in 4 groups: 0 = neither MetS or NAFLD (38.6%), 1 = NAFLD alone (12.4%), 2 = MetS alone (19.3%), 3 = both MetS and NAFLD (29.7%). Primary endpoint was a composite of CVEs. Mean age was 75.4 ± 9.4 years, and 41.4% of patients were women. During a mean follow-up of 34.1 ± 22.8 months (4,926.8 patient-years), 155 CVEs were recorded (incidence rate of 3.1%/year): 55 occurred in Group 0 (2.92%/year), 12 in Group 1 (2.17%/year), 45 in Group 2 (4.58%/year) and 43 in Group 3 (2.85%/year). Multivariable Cox regression analysis showed that use of DOACs, and female sex were inversely associated with CVEs, whilst age, heart failure, previous cardiac and cerebrovascular events, and group 2 (Group 2, Hazard Ratio 1.517, 95% Confidence Interval, 1.010-2.280) were directly associated with CVEs. In patients with AF, MetS increases the risk of CVEs. Patients with NAFLD alone have lower cardiovascular risk but may experience higher liver-related complications.
非酒精性脂肪性肝病（NAFLD）是否独立于代谢综合征（MetS）与心血管事件（CVE）风险增加有关仍存在争议。本研究旨在根据 MetS 和 NAFLD 的存在情况，研究非瓣膜性心房颤动（AF）高危人群中 CVE 的风险。这是一项前瞻性观察性多中心研究，共纳入 1735 名接受维生素 K 拮抗剂（VKA）或直接口服抗凝剂（DOAC）治疗的非瓣膜性 AF 患者。NAFLD 通过脂肪肝指数≥60 来定义。我们将患者分为 4 组：0=既无 MetS 也无 NAFLD（38.6%）、1=仅 NAFLD（12.4%）、2=仅 MetS（19.3%）、3=同时存在 MetS 和 NAFLD（29.7%）。主要终点是 CVE 的复合事件。平均年龄为 75.4±9.4 岁，41.4%的患者为女性。在平均 34.1±22.8 个月（4926.8 患者年）的随访期间，记录了 155 例 CVE（发生率为 3.1%/年）：0 组 55 例（2.92%/年）、1 组 12 例（2.17%/年）、2 组 45 例（4.58%/年）和 3 组 43 例（2.85%/年）。多变量 Cox 回归分析显示，使用 DOAC 和女性与 CVE 呈负相关，而年龄、心力衰竭、既往心脏和脑血管事件以及 2 组（2 组，风险比 1.517，95%置信区间，1.010-2.280）与 CVE 呈正相关。在 AF 患者中，MetS 增加了 CVE 的风险。仅患有 NAFLD 的患者心血管风险较低，但可能会经历更高的肝脏相关并发症。
