State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 BeiLiShi Road, XiCheng District, Beijing, 100037, People's Republic of China.
Department of Hepatology, MAFLD Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.
Hepatol Int. 2021 Dec;15(6):1337-1346. doi: 10.1007/s12072-021-10252-0. Epub 2021 Oct 9.
A consensus of experts suggests that nonalcoholic fatty liver disease (NAFLD) does not appropriately reflect current knowledge and metabolic-associated fatty liver disease (MAFLD) is supposed to be a more suitable overarching concept. However, the association of MAFLD with cardiovascular outcomes in patients with coronary artery disease has not been examined yet. Thus, this study aimed to assess the impact of MAFLD on major adverse cardiac events (MACEs) in patients with chronic coronary syndrome (CCS).
This study included 3306 patients with CCS who were diagnosed with MAFLD. Controls without MAFLD were matched (1:1) to cases by age and gender. All participants were followed up for the occurrence of MACEs. Finally, the association between MAFLD and the risk of MACEs was assessed.
During an average of 55.09 ± 19.92 months follow-up, 376 and 248 MACEs were observed in MAFLD and control groups, respectively. When compared with controls, Kaplan-Meier analysis showed that patients with MAFLD had significantly lower event-free survival rate and multivariate Cox regression analysis further revealed that MAFLD group had significantly increased MACEs risk (both p < 0.05). Stratification analysis suggested that patients with MAFLD overlapped with NAFLD or MAFLD-only had 1.33-fold and 2.32-fold higher risk of MACEs respectively compared with controls (both p < 0.05).
This study firstly showed that MAFLD was significantly associated with the risk of MACEs in patients with CCS. Moreover, this relationship remained unchanged irrespective of whether satisfying the NAFLD criteria, providing novel evidence for the good utility of MAFLD criteria in clinical practice.
专家共识认为，非酒精性脂肪性肝病（NAFLD）不能恰当地反映当前的知识，代谢相关脂肪性肝病（MAFLD）被认为是一个更合适的总体概念。然而，MAFLD 与冠心病患者的心血管结局的相关性尚未被研究。因此，本研究旨在评估 MAFLD 对慢性冠状动脉综合征（CCS）患者主要不良心脏事件（MACEs）的影响。
本研究纳入了 3306 例被诊断为 MAFLD 的 CCS 患者。对照组无 MAFLD，按年龄和性别与病例 1:1 匹配。所有参与者均随访 MACEs 的发生情况。最后，评估 MAFLD 与 MACEs 风险的相关性。
在平均 55.09±19.92 个月的随访期间，MAFLD 组和对照组分别观察到 376 例和 248 例 MACEs。与对照组相比，Kaplan-Meier 分析显示 MAFLD 组的无事件生存率显著降低，多变量 Cox 回归分析进一步显示 MAFLD 组的 MACEs 风险显著增加（均 P<0.05）。分层分析表明，MAFLD 重叠 NAFLD 或 MAFLD 仅的患者发生 MACEs 的风险分别比对照组高 1.33 倍和 2.32 倍（均 P<0.05）。
本研究首次表明，MAFLD 与 CCS 患者的 MACEs 风险显著相关。此外，无论是否符合 NAFLD 标准，这种关系都保持不变，为 MAFLD 标准在临床实践中的良好应用提供了新的证据。
