Sung Ki-Chul, Yoo Tae Kyung, Lee Mi Yeon, Byrne Christopher D, Zheng Ming-Hua, Targher Giovanni
Division of Cardiology, Department of Internal Medicine (K.-C.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Medicine, MetroWest Medical Center, Framingham, MA (T.K.Y.).
Arterioscler Thromb Vasc Biol. 2023 Mar;43(3):482-491. doi: 10.1161/ATVBAHA.122.318661. Epub 2023 Feb 2.
In cross-sectional and retrospective cohort studies, we examined comparative associations between nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) and risk of having or developing coronary artery calcification (CAC).
Participants who had health examinations between 2010 and 2019 were analyzed. Liver ultrasonography and coronary artery computed tomography were used to diagnose fatty liver and CAC. Participants were divided into a MAFLD and no-MAFLD group and then NAFLD and no-NAFLD groups. Participants were further divided into no fatty liver disease (reference), NAFLD-only, MAFLD-only, and both NAFLD and MAFLD groups. Logistic regression modeling was performed. Cox proportional hazard model was used to examine the risk of incident CAC in participants without CAC at baseline and who had at least two CAC measurements.
In cross-sectional analyses, 162 180 participants were included. Compared with either the no-NAFLD or no-MAFLD groups, the NAFLD and MAFLD groups were associated with a higher risk of prevalent CAC (NAFLD: adjusted odds ratio [OR], 1.34 [95% CI, 1.29-1.39]; MAFLD: adjusted OR, 1.44 [95% CI, 1.39-1.48]). Among the 4 groups, the MAFLD-only group had the strongest association with risk of prevalent CAC (adjusted OR, 1.60 [95% CI, 1.52-1.69]). Conversely, the NAFLD-only group was associated with a lower risk of prevalent CAC (adjusted OR, 0.76 [95% CI, 0.66-0.87]). In longitudinal analyses, 34 233 participants were included. Compared with either the no-NAFLD or no-MAFLD groups, the NAFLD and MAFLD groups were associated with a higher risk of incident CAC (NAFLD: adjusted hazard ratio, 1.68 [95% CI, 1.43-1.99]; MAFLD: adjusted hazard ratio, 1.82 [95% CI, 1.56-2.13]). Among these 4 groups, the MAFLD-only group had the strongest associations with risk of incident CAC (adjusted hazard ratio, 2.03,[95% CI, 1.62-2.55]). The NAFLD-only group was not independently associated with risk of incident CAC (adjusted hazard ratio, 0.88 [95% CI, 0.44-1.78]) Conclusions: Both NAFLD and MAFLD are significantly associated with an increased prevalence and incidence of CAC. These associations tended to be stronger for MAFLD.
在横断面研究和回顾性队列研究中，我们检查了非酒精性脂肪性肝病（NAFLD）与代谢功能障碍相关脂肪性肝病（MAFLD）之间的比较关联以及发生冠状动脉钙化（CAC）的风险。
对2010年至2019年间进行健康检查的参与者进行分析。使用肝脏超声和冠状动脉计算机断层扫描来诊断脂肪肝和CAC。参与者被分为MAFLD组和非MAFLD组，然后再分为NAFLD组和非NAFLD组。参与者进一步分为无脂肪性肝病（参照组）、仅NAFLD组、仅MAFLD组以及NAFLD和MAFLD均有的组。进行逻辑回归建模。使用Cox比例风险模型检查基线时无CAC且至少有两次CAC测量值的参与者发生CAC的风险。
在横断面分析中，纳入了162180名参与者。与非NAFLD组或非MAFLD组相比，NAFLD组和MAFLD组发生CAC的风险更高（NAFLD：调整后的优势比[OR]，1.34[95%CI，1.29 - 1.39]；MAFLD：调整后的OR，1.44[95%CI，1.39 - 1.48]）。在这4组中，仅MAFLD组与发生CAC的风险关联最强（调整后的OR，1.60[95%CI，1.52 - 1.69]）。相反，仅NAFLD组发生CAC的风险较低（调整后的OR，0.76[95%CI，0.66 - 0.87]）。在纵向分析中，纳入了34233名参与者。与非NAFLD组或非MAFLD组相比，NAFLD组和MAFLD组发生CAC的风险更高（NAFLD：调整后的风险比，1.68[95%CI，1.43 - 1.99]；MAFLD：调整后的风险比，1.82[95%CI，1.56 - 2.13]）。在这4组中，仅MAFLD组与发生CAC的风险关联最强（调整后的风险比，2.03，[95%CI，1.62 - 2.55]）。仅NAFLD组与发生CAC的风险无独立关联（调整后的风险比，0.88[95%CI，0.44 - 1.78]）。结论：NAFLD和MAFLD均与CAC患病率和发病率的增加显著相关。这些关联在MAFLD中往往更强。
