Wang Xinyu, Cheng Si, Lv Jun, Yu Canqing, Guo Yu, Pei Pei, Yang Ling, Millwood Iona Y, Walters Robin, Chen Yiping, Du Huaidong, Duan Haiping, Gilbert Simon, Avery Daniel, Chen Junshi, Pang Yuanjie, Chen Zhengming, Li Liming
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China.
Front Cardiovasc Med. 2022 Aug 11;9:938902. doi: 10.3389/fcvm.2022.938902. eCollection 2022.
Liver biomarkers and metabolic associated fatty liver disease (MAFLD) have been shown to be associated with cardiovascular disease (CVD). However, there is limited evidence on CVD subtypes [myocardial infarction (MI), ischemic stroke (IS), and intracerebral hemorrhage (ICH)], especially in the Chinese population. We examined these associations overall, by genetic predisposition to non-alcoholic fatty liver disease (NAFLD), and by lifestyle risk factors.
This is a nested case-control study of CVD (10,298 cases and 5,388 controls) within the China Kadoorie Biobank. Cox regression was used to estimate adjusted hazard ratios (HRs) for CVD associated with liver biomarkers and MAFLD and by stratum of genetic risk and a combined high-risk lifestyle score. For liver enzymes, there were positive associations with MI and IS, but no associations with ICH or carotid plaque. There were positive associations of NAFLD with risks of MI, IS, and ICH (HR 1.43 [95% CI 1.30-1.57], 1.25 [1.16-1.35], and 1.12 [1.02-1.23]) as well as carotid plaque (odds ratio 2.36 [1.12-4.96]). The associations of NAFLD with CVD and carotid plaque were stronger among individuals with a high genetic risk (ICH: -interaction < 0.05), while the associations with stroke were stronger among those with a favorable lifestyle (-interaction < 0.05). The results for MAFLD mirrored those for NAFLD.
In Chinese adults, liver biomarkers and MAFLD were associated with risk of CVD, with different magnitudes of associations by CVD subtypes. Genetic predisposition to NAFLD and lifestyle factors modified the associations of fatty liver with stroke.
肝脏生物标志物和代谢相关脂肪性肝病（MAFLD）已被证明与心血管疾病（CVD）相关。然而，关于CVD亚型[心肌梗死（MI）、缺血性中风（IS）和脑出血（ICH）]的证据有限，尤其是在中国人群中。我们从总体上、非酒精性脂肪性肝病（NAFLD）的遗传易感性以及生活方式风险因素方面研究了这些关联。
这是一项在中国嘉道理生物银行中进行的关于CVD（10298例病例和5388例对照）的巢式病例对照研究。采用Cox回归来估计与肝脏生物标志物和MAFLD相关的CVD的调整后风险比（HR），并按遗传风险分层和综合高危生活方式评分进行分析。对于肝酶，其与MI和IS呈正相关，但与ICH或颈动脉斑块无关联。NAFLD与MI、IS和ICH的风险呈正相关（HR分别为1.43[95%CI 1.30 - 1.57]、1.25[1.16 - 1.35]和1.12[1.02 - 1.23]），以及与颈动脉斑块也呈正相关（优势比为2.36[1.12 - 4.96]）。NAFLD与CVD和颈动脉斑块的关联在高遗传风险个体中更强（ICH：交互作用P<0.05），而与中风的关联在生活方式良好的个体中更强（交互作用P<0.05）。MAFLD的结果与NAFLD相似。
在中国成年人中，肝脏生物标志物和MAFLD与CVD风险相关，且不同CVD亚型的关联程度不同。NAFLD的遗传易感性和生活方式因素改变了脂肪肝与中风的关联。
