Department of Clinical Research The First Affiliated Hospital of Jinan University Guangzhou Guangdong China.
School of Public Health Xi'an Jiaotong University Health Science Center Xi'an Shaanxi China.
J Am Heart Assoc. 2023 Dec 5;12(23):e031440. doi: 10.1161/JAHA.123.031440. Epub 2023 Nov 28.
The role of nonalcoholic fatty liver disease (NAFLD) as a mediator in the association between various unhealthy lifestyles and major adverse cardiovascular events and all-cause death remains unclear.
This study used data from the UK Biobank, with follow-up until the end of 2021. It involved the calculation of unweighted and weighted lifestyle scores using the Cox model to classify participants on the basis of these scores. Additionally, the research assessed the mediation effect proportion of NAFLD using the difference method and examined the interaction and joint effects of lifestyle and NAFLD on health outcomes. Among the 134 616 enrolled participants, 4024 had records of major adverse cardiovascular events, while among the 130 144 participants included in the analysis of all-cause death, 6697 deaths occurred. The proportions of the association between overall lifestyle and major adverse cardiovascular events mediated by NAFLD were 19.4% and 21.7% (95% CI, 16.2-22.6 and 17.8-25.7) for scores 1 and 2, respectively, and those for all-cause death were 14.1% and 10.1% (95% CI, 11.3-17.1 and 7.9-12.2). After fully adjusting for traditional cardiovascular risk factors, the mediating effects declined across both outcomes. The associations between overall lifestyle and outcomes were stronger among those of the non-NAFLD group, and significant interactions were observed between overall lifestyle and NAFLD status. The joint analysis revealed that patients with NAFLD with unhealthy lifestyle had the highest risk of major adverse cardiovascular events and all-cause death.
Improving lifestyle and addressing metabolic risk factors are essential for cardiovascular risk management in patients with NAFLD.
非酒精性脂肪性肝病（NAFLD）作为各种不健康生活方式与主要不良心血管事件和全因死亡之间关联的中介因素的作用尚不清楚。
本研究使用了英国生物库的数据，随访至 2021 年底。研究使用 Cox 模型计算未经加权和加权的生活方式评分，根据这些评分对参与者进行分类。此外，研究还使用差异法评估了 NAFLD 的中介效应比例，并检验了生活方式和 NAFLD 对健康结果的交互和联合效应。在纳入的 134616 名参与者中，有 4024 人有主要不良心血管事件的记录，而在纳入全因死亡分析的 130144 名参与者中，有 6697 人死亡。NAFLD 介导的整体生活方式与主要不良心血管事件之间的关联比例，评分 1 和 2 分别为 19.4%和 21.7%（95%CI，16.2-22.6 和 17.8-25.7），全因死亡的比例分别为 14.1%和 10.1%（95%CI，11.3-17.1 和 7.9-12.2）。在充分调整传统心血管危险因素后，两种结局的中介效应均下降。在非 NAFLD 组中，整体生活方式与结局之间的关联更强，并且观察到整体生活方式与 NAFLD 状态之间存在显著的交互作用。联合分析显示，患有 NAFLD 且生活方式不健康的患者发生主要不良心血管事件和全因死亡的风险最高。
改善生活方式和解决代谢危险因素对 NAFLD 患者的心血管风险管理至关重要。
