Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Gastroenterology and Hepatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark.
Clin Gastroenterol Hepatol. 2023 Jul;21(7):1841-1853.e12. doi: 10.1016/j.cgh.2022.10.022. Epub 2022 Nov 1.
BACKGROUND & AIMS: Patients with alcohol-related liver disease (ALD) frequently have risk factors for cardiovascular disease (CVD), but their long-term risk of CVD is not well-known, especially considering the competing risk of death from liver-related causes. It is further unknown if any excess risk varies across histological subgroups.
We investigated the risk of CVD outcomes in 3488 persons with ALD and an available liver biopsy in Sweden between 1969 and 2016, compared with a matched reference population (n = 15,461). Administrative coding from national diagnostic and histopathology registers were used to define exposures and outcomes. Competing risk regression, taking non-CVD death into account and adjusting for potential confounders, was used to estimate subdistribution hazard ratios for incident CVD up until Dec 31, 2019.
At baseline, patients with ALD had a median age of 58 years, 64% were men, and 2039 (58%) had cirrhosis on histology. The incidence rate of CVD was 35.6 per 1000 person-years in ALD compared with 19.0 per 1000 person-years in reference individuals. ALD was associated with a 2-fold increased short-term risk for CVD compared with matched reference individuals (subdistribution hazard ratio during the first year after diagnosis, 2.29; 95% confidence interval, 1.79-2.95), but this risk decreased with time. Incidence rates of CVD were comparable across histological subgroups (ranging from 27.4 CVD cases per 1000 person-years in those with normal histology to 39.2 cases per 1000 person-years in those with cirrhosis).
Persons with biopsy-proven ALD have increased rates of CVD across histological subgroups compared with matched reference individuals, particularly just after ALD diagnosis. Active surveillance of modifiable CVD risk factors should be considered by clinicians treating patients with ALD.
患有酒精相关性肝病（ALD）的患者常伴有心血管疾病（CVD）的危险因素，但他们的 CVD 长期风险尚不清楚，尤其是考虑到死于与肝脏相关原因的竞争风险。目前尚不清楚任何额外风险是否因组织学亚组而异。
我们研究了在瑞典 1969 年至 2016 年间的 3488 名接受过肝活检的 ALD 患者和一个可获得的对照人群（n=15461）的 CVD 结局风险。使用来自国家诊断和组织病理学登记处的行政编码来定义暴露和结局。使用竞争风险回归，考虑非 CVD 死亡并调整潜在混杂因素，来估计截至 2019 年 12 月 31 日的新发 CVD 的亚分布危险比。
在基线时，ALD 患者的中位年龄为 58 岁，64%为男性，2039 名（58%）患者的组织学表现为肝硬化。与对照个体相比，ALD 患者的 CVD 发病率为 35.6/1000 人年，而对照个体为 19.0/1000 人年。与匹配的对照个体相比，ALD 在短期内发生 CVD 的风险增加了一倍（诊断后第一年的亚分布危险比为 2.29；95%置信区间为 1.79-2.95），但随着时间的推移，这种风险逐渐降低。在组织学亚组中，CVD 的发生率相当（在组织学正常的患者中为每 1000 人年 27.4 例 CVD，在肝硬化患者中为每 1000 人年 39.2 例）。
与匹配的对照个体相比，经肝活检证实的 ALD 患者在各个组织学亚组中 CVD 发生率均升高，尤其是在 ALD 诊断后不久。治疗 ALD 患者的临床医生应考虑对可改变的 CVD 危险因素进行积极监测。
