Kablawi Dana, Aljohani Faisal, Palumbo Chiara Saroli, Restellini Sophie, Bitton Alain, Wild Gary, Afif Waqqas, Lakatos Peter L, Bessissow Talat, Sebastiani Giada
Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada.
Division of Gastroenterology, Jewish General Hospital, Montreal, Quebec, Canada.
Crohns Colitis 360. 2023 Feb 2;5(1):otad004. doi: 10.1093/crocol/otad004. eCollection 2023 Jan.
Nonalcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. Both conditions seem more frequent in patients with inflammatory bowel disease (IBD). We aimed to assess the effect of NAFLD and liver fibrosis on intermediate-high cardiovascular risk in IBD.
We prospectively included IBD patients undergoing a routine screening program for NAFLD by transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD and significant liver fibrosis were defined as CAP ≥275 dB m and liver stiffness measurement by TE ≥8 kPa, respectively. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator and categorized as low if <5%, borderline if 5%-7.4%, intermediate if 7.5%-19.9%, and high if ≥20% or if previous cardiovascular event. Predictors of intermediate-high cardiovascular risk were investigated by multivariable logistic regression analysis.
Of 405 patients with IBD included, 278 (68.6%), 23 (5.7%), 47 (11.6%), and 57 (14.1%) were categorized as at low, borderline, intermediate, and high ASCVD risk, respectively. NAFLD and significant liver fibrosis were found in 129 (31.9%) and 35 (8.6%) patients, respectively. After adjusting for disease activity, significant liver fibrosis and body mass index, predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.97, 95% CI, 1.56-5.68), IBD duration (aOR 1.55 per 10 years, 95% CI, 1.22-1.97), and ulcerative colitis (aOR 2.32, 95% CI, 1.35-3.98).
Assessment of cardiovascular risk should be targeted in IBD patients with NAFLD, particularly if they have longer IBD duration and ulcerative colitis.
在普通人群中，非酒精性脂肪性肝病（NAFLD）与心血管疾病密切相关。这两种疾病在炎症性肠病（IBD）患者中似乎更为常见。我们旨在评估NAFLD和肝纤维化对IBD患者中高心血管风险的影响。
我们前瞻性纳入了通过瞬时弹性成像（TE）及相关受控衰减参数（CAP）进行NAFLD常规筛查的IBD患者。NAFLD和显著肝纤维化分别定义为CAP≥275 dB m和通过TE测量的肝脏硬度≥8 kPa。使用动脉粥样硬化性心血管疾病（ASCVD）风险评估器评估心血管风险，若<5%则分类为低风险，5%-7.4%为临界风险，7.5%-19.9%为中度风险，≥20%或既往有心血管事件则为高风险。通过多变量逻辑回归分析研究中高心血管风险的预测因素。
纳入的405例IBD患者中，分别有278例（68.6%）、23例（5.7%）、47例（11.6%）和57例（14.1%）被分类为ASCVD低风险、临界风险、中度风险和高风险。分别在129例（31.9%）和35例（8.6%）患者中发现了NAFLD和显著肝纤维化。在调整疾病活动度、显著肝纤维化和体重指数后，中高ASCVD风险的预测因素为NAFLD（调整后的优势比[aOR] 2.97，95%置信区间[CI]，1.56-5.68）、IBD病程（每10年aOR 1.55，95% CI，1.22-1.97）和溃疡性结肠炎（aOR 2.32，95% CI，1.35-3.98）。
对于患有NAFLD的IBD患者，尤其是IBD病程较长和患有溃疡性结肠炎的患者，应针对性地评估心血管风险。
