肝脂肪变性个体心血管疾病的危险因素。
Risk factors for cardiovascular disease among individuals with hepatic steatosis.
机构信息
Cardiovascular Imaging Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
出版信息
Hepatol Commun. 2022 Dec;6(12):3406-3420. doi: 10.1002/hep4.2090. Epub 2022 Oct 25.
Cardiovascular disease (CVD) is the leading cause of mortality in adults with hepatic steatosis (HS). However, risk factors for CVD in HS are unknown. We aimed to identify factors associated with coronary artery disease (CAD) and incident major adverse cardiovascular events (MACE) in individuals with HS. We performed a nested cohort study of adults with HS detected on coronary computed tomography in the PROspective Multicenter Imaging Study for Evaluation of chest pain (PROMISE) trial. Obstructive CAD was defined as ≥50% coronary stenosis. MACE included hospitalization for unstable angina, nonfatal myocardial infarction, or all-cause death. Multivariate modeling, adjusted for age, sex, atherosclerotic CVD (ASCVD) risk score and body mass index, identified factors associated with obstructive CAD. Cox regression, adjusted for ASCVD risk score, determined the predictors of MACE. A total of 959 of 3,756 (mean age 59.4 years, 55.0% men) had HS. Obstructive CAD was present in 15.2% (145 of 959). Male sex (adjusted odds ratio [aOR] = 1.83, 95% confidence interval [CI] 1.18-1.2.84; p = 0.007), ASCVD risk score (aOR = 1.05, 95% CI 1.03-1.07; p < 0.001), and n-terminal pro-b-type natriuretic peptide (NT-proBNP; aOR = 1.90, 95% CI 1.38-2.62; p < 0.001) were independently associated with obstructive CAD. In the 25-months median follow-up, MACE occurred in 4.4% (42 of 959). Sedentary lifestyle (adjusted hazard ratio [aHR] = 2.53, 95% CI 1.27-5.03; p = 0.008) and NT-proBNP (aOR = 1.50, 95% CI 1.01-2.25; p = 0.046) independently predicted MACE. Furthermore, the risk of MACE increased by 3% for every 1% increase in ASCVD risk score (aHR = 1.03, 95% CI 1.01-1.05; p = 0.02). Conclusion: In individuals with HS, male sex, NT-pro-BNP, and ASCVD risk score are associated with obstructive CAD. Furthermore, ASCVD, NT-proBNP, and sedentary lifestyle are independent predictors of MACE. These factors, with further validation, may help risk-stratify adults with HS for incident CAD and MACE.
心血管疾病（CVD）是患有肝脂肪变性（HS）的成年人的主要死亡原因。然而，HS 患者 CVD 的危险因素尚不清楚。我们旨在确定与 HS 个体的冠状动脉疾病（CAD）和主要不良心血管事件（MACE）事件相关的因素。我们对 PROspective Multicenter Imaging Study for Evaluation of chest pain（PROMISE）试验中通过冠状动脉计算机断层扫描检测到的 HS 成年人进行了嵌套队列研究。阻塞性 CAD 的定义为≥50%的冠状动脉狭窄。MACE 包括不稳定型心绞痛、非致死性心肌梗死或全因死亡的住院治疗。多变量模型调整了年龄、性别、动脉粥样硬化性心血管疾病（ASCVD）风险评分和体重指数，以确定与阻塞性 CAD 相关的因素。使用 Cox 回归模型，调整了 ASCVD 风险评分，确定了 MACE 的预测因素。共有 3756 名成年人中的 959 名（平均年龄 59.4 岁，55.0%为男性）患有 HS。15.2%（145 名）患有阻塞性 CAD。男性（调整后的优势比[aOR]为 1.83，95%置信区间[CI]为 1.18-1.28；p=0.007）、ASCVD 风险评分（aOR 为 1.05，95%CI 为 1.03-1.07；p<0.001）和 N 端脑钠肽前体（NT-proBNP；aOR 为 1.90，95%CI 为 1.38-2.62；p<0.001）与阻塞性 CAD 独立相关。在中位随访 25 个月期间，959 名成年人中有 4.4%（42 名）发生了 MACE。久坐的生活方式（调整后的危害比[aHR]为 2.53，95%CI 为 1.27-5.03；p=0.008）和 NT-proBNP（aOR 为 1.50，95%CI 为 1.01-2.25；p=0.046）独立预测了 MACE。此外，ASCVD 风险评分每增加 1%，MACE 的风险增加 3%（aHR 为 1.03，95%CI 为 1.01-1.05；p=0.02）。结论：在患有 HS 的成年人中，男性、NT-proBNP 和 ASCVD 风险评分与阻塞性 CAD 相关。此外，ASCVD、NT-proBNP 和久坐的生活方式是 MACE 的独立预测因素。这些因素，经过进一步验证，可能有助于对患有 HS 的成年人进行 CAD 和 MACE 事件的风险分层。
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