Cho Yun Kyung, Kim Myungjin, Kim Ye-Jee, Jung Chang Hee, Lee Woo Je, Park Joong-Yeol
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea.
Front Cardiovasc Med. 2023 Jul 18;10:1163052. doi: 10.3389/fcvm.2023.1163052. eCollection 2023.
Non-alcoholic fatty liver disease (NAFLD) is common and is associated with cardiovascular (CV) disease and mortality. The Framingham steatosis index (FSI) was recently proposed as a diagnostic marker of NAFLD and was calculated from age, body mass index, triglyceride, aspartate aminotransferase, alanine aminotransferase, diabetes history, and hypertension status. We aimed to evaluate the predictive ability of FSI for CV risk using a large-scale population dataset from the Korean National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS).
Among 514,866 individuals in the NHIS-HEALS, we excluded those who died, had a history of admission due to a CV event, and were heavy drinkers. The final study cohort comprised 283,427 participants. We employed both unadjusted and covariate-adjusted models in Cox proportional hazards regression analyses to determine the association between FSI and major adverse cardiovascular events (MACEs), CV events, and CV mortality.
During a median follow-up of 5.9 years, we documented 9,674, 8,798, and 1,602 cases of MACEs, CV events, and CV mortality, respectively. The incidence of MACEs was 1.28%, 2.99%, 3.94%, and 4.82% in the first to fourth quartiles of FSI, respectively. The adjusted hazard ratios (95% confidence interval) for MACEs gradually and significantly increased with the FSI quartiles [1.302 (1.215-1.395) in Q2, 1.487 (1.390-1.590) in Q3, and 1.792 (1.680-1.911) in Q4], following an adjustment for conventional CV risk factors, including age, sex, smoking, drinking, physical activities, low-density lipoprotein cholesterol, estimated glomerular filtration rate, and waist circumference. Participants in the higher quartiles of FSI exhibited a noteworthy increase in the occurrence of CV event. However, upon adjusting for relevant risk factors, the association between FSI and CV mortality did not reach statistical significance.
Our study suggests that the FSI, which is a surrogate marker of NAFLD, has a prognostic value for detecting individuals at higher risk of CV events.
非酒精性脂肪性肝病（NAFLD）很常见，且与心血管（CV）疾病及死亡率相关。最近提出的弗雷明汉脂肪变性指数（FSI）作为NAFLD的诊断标志物，其由年龄、体重指数、甘油三酯、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、糖尿病史及高血压状态计算得出。我们旨在利用韩国国民健康保险服务 - 国家健康筛查队列（NHIS - HEALS）的大规模人群数据集评估FSI对心血管风险的预测能力。
在NHIS - HEALS的514,866名个体中，我们排除了那些死亡、有因心血管事件入院史及重度饮酒者。最终研究队列包括283,427名参与者。我们在Cox比例风险回归分析中采用未调整及协变量调整模型，以确定FSI与主要不良心血管事件（MACE）、心血管事件及心血管死亡率之间的关联。
在中位随访5.9年期间，我们分别记录到9,674例、8,798例和1,602例MACE、心血管事件及心血管死亡病例。FSI第一至第四四分位数中MACE的发生率分别为1.28%、2.99%、3.94%和4.82%。在对包括年龄、性别、吸烟、饮酒、身体活动、低密度脂蛋白胆固醇、估计肾小球滤过率及腰围等传统心血管危险因素进行调整后，MACE的调整后风险比（95%置信区间）随FSI四分位数逐渐且显著增加[第二四分位数为1.302（1.215 - 1.395），第三四分位数为1.487（1.390 - 1.590），第四四分位数为1.792（1.680 - 1.911）]。FSI较高四分位数的参与者心血管事件发生率显著增加。然而，在对相关危险因素进行调整后，FSI与心血管死亡率之间的关联未达到统计学显著性。
我们的研究表明，作为NAFLD替代标志物的FSI，对于检测心血管事件高风险个体具有预后价值。
