Niu Yuyu, Wang Guifang, Feng Xianjun, Niu Hongyi, Shi Wenrui
Department of Cardiovascular Medicine, First People's Hospital of Xinxiang City and The Fifth Affiliated Hospital of Xinxiang Medical College, Xinxiang, China.
Sanquan College, Xinxiang Medical University, Xinxiang, China.
Front Cardiovasc Med. 2023 Oct 12;10:1171754. doi: 10.3389/fcvm.2023.1171754. eCollection 2023.
Non-alcoholic fatty liver disease (NAFLD) contributes to the development of ischemic heart disease via multiple mechanisms. Fatty liver index (FLI) has been proposed as an accurate, convenient, and economic surrogate of the severity of NAFLD. Our present study aims to assess the association between FLI and the prevalent IHD and to evaluate the potential value of FLI to refine the detection of prevalent IHD in the general population.
Our work recruited 32,938 subjects from the National Health and Nutrition Examination Survey 1999-2016. IHD was diagnosed according to the subjects' self-report. FLI was determined based on triglycerides, BMI, -glutamyltransferase, and waist circumference.
2,370 (7.20%) subjects were diagnosed with IHD. After adjustment of age, sex, race, current smoking, current drinking, PIR, BMI, WC, TC, TG, GGT, Scr, FPG, SBP, anti-hypertensive therapy, anti-diabetic therapy, and lipid-lowering therapy, one standard deviation increase of FLI resulted in a 27.0% increment of the risk of prevalent IHD. In the quartile analysis, we observed a 1.684 times risk of prevalent IHD when comparing the fourth quartile with the first quartile, and there was a trend towards higher risk across the quartiles. The smooth curve fitting displayed a linear relationship between FLI and the presence of IHD without any threshold or saturation effect. Subgroup analysis revealed a robust association in conventional cardiovascular subpopulations, and the association could be more prominent in female subjects and diabetes patients. ROC analysis demonstrated an incremental value of FLI for detecting prevalent IHD after introducing it to conventional cardiovascular risk factors (AUC: 0.823 vs. 0.859, for comparison <0.001). Also, results from reclassification analysis implicated that more IHD patients could be correctly identified by introducing FLI into conventional cardiovascular risk factors (continuous net reclassification index: 0.633, < 0.001; integrated discrimination index: 0.034, < 0.001).
The current analysis revealed a positive and linear relationship between FLI and the prevalent IHD. Furthermore, our findings suggest the incremental value of FLI to refine the detection of prevalent IHD in the general population.
非酒精性脂肪性肝病（NAFLD）通过多种机制促进缺血性心脏病的发展。脂肪肝指数（FLI）已被提议作为NAFLD严重程度的一种准确、便捷且经济的替代指标。我们目前的研究旨在评估FLI与缺血性心脏病患病率之间的关联，并评估FLI在改善普通人群中缺血性心脏病患病率检测方面的潜在价值。
我们的研究从1999 - 2016年国家健康与营养检查调查中招募了32938名受试者。缺血性心脏病根据受试者的自我报告进行诊断。FLI根据甘油三酯、体重指数、γ-谷氨酰转移酶和腰围来确定。
2370名（7.20%）受试者被诊断为缺血性心脏病。在调整年龄、性别、种族、当前吸烟状况、当前饮酒状况、贫困收入比、体重指数、腰围、总胆固醇、甘油三酯、γ-谷氨酰转移酶、血清肌酐、空腹血糖、收缩压、抗高血压治疗、抗糖尿病治疗和降脂治疗后，FLI每增加一个标准差，缺血性心脏病患病率的风险增加27.0%。在四分位数分析中，将第四四分位数与第一四分位数相比，我们观察到缺血性心脏病患病率的风险增加了1.684倍，并且在各四分位数之间存在风险升高的趋势。平滑曲线拟合显示FLI与缺血性心脏病的存在之间呈线性关系，没有任何阈值或饱和效应。亚组分析显示在传统心血管亚组中存在显著关联，并且这种关联在女性受试者和糖尿病患者中可能更突出。ROC分析表明，在将FLI引入传统心血管危险因素后，其在检测缺血性心脏病患病率方面具有增加值（AUC：0.823对0.859，比较P <0.001）。此外，重新分类分析的结果表明，将FLI引入传统心血管危险因素可以正确识别更多的缺血性心脏病患者（连续净重新分类指数：0.633，P <0.001；综合判别指数：0.034，P <0.001）。
当前分析揭示了FLI与缺血性心脏病患病率之间呈正线性关系。此外，我们的研究结果表明FLI在改善普通人群中缺血性心脏病患病率检测方面具有增加值。
