Minhas Abdul Mannan Khan, Jain Vardhmaan, Maqsood Muhammad Haisum, Pandey Ambarish, Khan Sadiya S, Fudim Marat, Fonarow Gregg C, Butler Javed, Khan Muhammad Shahzeb
Department of Medicine, Forrest General Hospital, Hattiesburg, MS.
Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH.
Curr Probl Cardiol. 2022 Dec;47(12):101333. doi: 10.1016/j.cpcardiol.2022.101333. Epub 2022 Jul 25.
To evaluate the association between non-alcoholic fatty liver disease (NAFLD), heart failure (HF), and all-cause mortality. Both NAFLD and HF are increasing in prevalence due to shared risk factors. We used data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 to identify non-pregnant individuals aged ≥20 years with HF and NAFLD and linked with the cause of death data from the National Center for Health Statistics. The associations between NAFLD, HF, and all-cause mortality were assessed using logistic regression and Cox proportional hazard modeling as appropriate. There were 82,358,893 weighted eligible participants of whom 3,833,667 (4.7%) had NAFLD. The mean (SE) age was 51.5 (0.35) years, 45.1% women, 63.0% Non-Hispanic White and 11.8% Non-Hispanic Black. Cardiovascular comorbidities were more common in participants with NAFLD; they were more likely to have hypertension (81.7% vs 53.5%), diabetes (65.1% vs 17.1%), stroke (7.3% vs 4.1%), coronary artery disease (14.9% vs 8.4%), or HF (10.5% v s 3.5%) compared with participants without NAFLD. In multivariate logistic regression models adjusting for age, race/ethnicity and sex, participants with NAFLD were 3.5 times more likely to have HF [aOR, 95% CI: 3.47 (1.98-6.06)]. Older age, male sex, presence of diabetes and coronary artery disease were associated with higher odds of HF in participants with established NAFLD. At the end of the follow-up period, participants with NAFLD had higher all-cause mortality compared with participants without NAFLD (HR [95% CI]: 1.93 [1.24-2.99], P < 0.001). In this analysis of US adults, ambulatory participants with NAFLD were ∼3.5 times more likely to have HF, and twice as likely to experience mortality compared with participants without NAFLD. Further studies are needed to identify the possible linkage between NAFLD and HF beyond the shared risk factor pathogenesis.
评估非酒精性脂肪性肝病（NAFLD）、心力衰竭（HF）与全因死亡率之间的关联。由于存在共同的风险因素，NAFLD和HF的患病率均在上升。我们使用了2005 - 2018年美国国家健康与营养检查调查（NHANES）的数据，以确定年龄≥20岁的非妊娠HF和NAFLD患者，并将其与国家卫生统计中心的死亡原因数据相链接。根据情况，使用逻辑回归和Cox比例风险模型评估NAFLD、HF与全因死亡率之间的关联。共有82358893名加权合格参与者，其中3833667人（4.7%）患有NAFLD。平均（SE）年龄为51.5（0.35）岁，女性占45.1%，非西班牙裔白人占63.0%，非西班牙裔黑人占11.8%。心血管合并症在患有NAFLD的参与者中更为常见；与未患NAFLD的参与者相比，他们更有可能患有高血压（81.7%对53.5%）、糖尿病（65.1%对17.1%）、中风（7.3%对4.1%）、冠状动脉疾病（14.9%对8.4%）或HF（10.5%对3.5%）。在调整了年龄、种族/族裔和性别的多变量逻辑回归模型中，患有NAFLD的参与者患HF的可能性高3.5倍[aOR，95%CI：3.47（1.98 - 6.06）]。年龄较大、男性、患有糖尿病和冠状动脉疾病与已确诊NAFLD的参与者患HF的较高几率相关。在随访期结束时，患有NAFLD的参与者与未患NAFLD的参与者相比，全因死亡率更高（HR[95%CI]：1.93[1.24 - 2.99]，P<0.001）。在这项对美国成年人的分析中，患有NAFLD的门诊参与者患HF的可能性是非NAFLD参与者的约3.5倍，死亡可能性是其两倍。需要进一步的研究来确定NAFLD和HF之间除了共同的风险因素发病机制之外的可能联系。
