The Association between Non-Invasive Hepatic Fibrosis Markers and Cardiometabolic Risk Factors in the Framingham Heart Study - PubMed (original) (raw)

The Association between Non-Invasive Hepatic Fibrosis Markers and Cardiometabolic Risk Factors in the Framingham Heart Study

Michelle T Long et al. PLoS One. 2016.

Abstract

Background & aims: Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular related death, particularly in those with hepatic fibrosis. We determined the prevalence of predicted fibrosis based on non-invasive fibrosis markers and the association of hepatic fibrosis with cardiovascular risk factors.

Methods: Cross-sectional study of 575 Framingham Heart Study participants with NAFLD based on computed tomography. We determined the prevalence of predicted fibrosis based on the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, AST to platelet ratio index (APRI), the Fibrosis-4 score (FIB4), and the NAFLD Fibrosis Score (NFS). Using multivariable logistic regression models, we examined the association between low, indeterminate, or high risk for fibrosis according to the NFS and various cardiometabolic risk factors.

Results: The predicted risk of fibrosis was 12%, 4%, 5%, and 32% for the NFS, FIB4, APRI, and AST/ALT ratio, respectively. In multivariable models, participants with a high risk for advanced fibrosis by the NFS had a wider pulse pressure (adjusted mean difference = 6.87 mm Hg; p = 0.0002) and an increased odds of hypertension (OR 2.92; p = 0.007) compared to those with low risk of fibrosis. There were no statistically significant differences between other cardiovascular risk factors for those with a high versus low risk of fibrosis.

Conclusions: The AST/ALT ratio, APRI, and NFS give widely disparate predictions of liver fibrosis. Participants with a high risk for fibrosis based on NFS had wider pulse pressure and increased odds of hypertension. Whether modifying these risk factors impacts cardiovascular endpoints in NAFLD patients remains unknown.

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Conflict of interest statement

Competing Interests: Alison Pedley is an employee of Merck. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. The other authors have no conflicts to report.

Figures

Fig 1

Fig 1. Prediction of the risk for liver fibrosis among participants with NAFLD (n = 575) according to the AST/ALT ratio, APRI, FIB4, and NFS.

For the AST/ALT ratio, significant risk of fibrosis was defined as an AST/ALT ratio > 1.0 and absence of significant fibrosis as an AST/ALT ratio ≤ 1.0. *We also show the predicted risk of fibrosis for the AST/ALT ratio using the 0.8 cut-off. For the APRI, a significant risk/intermediate risk of fibrosis was defined as an APRI > 0.5 while an absence of fibrosis was defined as APRI ≤ 0.5. For the FIB4, we defined significant fibrosis as a FIB4 > 2.67 and a low risk of fibrosis as FIB4 < 1.30 with values in-between defined as indeterminate. For the NFS, we used the following definitions for the risk categories: high risk advanced fibrosis (NFS > 0.676), indeterminate risk for advanced fibrosis (1.455 ≤ NFS ≤ 0.676), and low risk for advanced fibrosis (NFS < -1.455).

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