Among Patients With NAFLD, Treatment of Dyslipidemia Does Not Reduce Cardiovascular Mortality (original) (raw)
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MAFLD AND NAFLD: is there the need for redefining the risk of cardiovascular disease and mortality
Metabolism and Target Organ Damage, 2021
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and is characterized by a high burden of metabolic alterations. It exposes patients to increased morbidity and mortality, mostly driven by cardiovascular (CV) complications. Despite its large use, the nomenclature NAFLD has some limitations, due to the exclusion of patients with hepatic fat and concomitant other liver diseases or moderate alcohol consumption possibly contributing to hepatic damage. Therefore, a new and more inclusive dvefinition of fatty liver has recently been proposed, namely metabolic associated fatty liver disease (MAFLD). It comprises patients with hepatic steatosis and associated metabolic comorbidities, without exclusion of other liver diseases. As for the nature of the new definition of MAFLD, it could be speculated that an increased risk of cardiovascular complications should be expected. Therefore, our review aims at answering the question about possible differences in cardiovascular risk and mortality in patients with NAFLD compared to MAFLD. We selected 8 studies out of 1130 by searching in the PubMed database. Data from literature seem to report an increased risk of CV events and mortality in patients affected by MAFLD compared to NAFLD, possibly due to the metabolic burden and coexistence of other liver diseases typical of MAFLD. However, further prospective studies are warranted to confirm this preliminary hypothesis.
Journal of Clinical and Experimental Hepatology, 2017
Background and Aim: Non-alcoholic fatty liver disease (NAFLD) in type 2 diabetics is the stepping stone to unfavourable health outcomes. The metabolic aberrations that occur in each grade of ultrasonographic NAFLD have been meagrely explored. Therefore, we aimed to assess the metabolic aberrations in different grades of ultrasonographic NAFLD in type 2 diabetics. Methods: Type 2 diabetics with NAFLD {(N = 74); (13.51% grade 1 steatosis, 78.4% grade 2 steatosis and 8.1% grade 3 steatosis)} were enrolled from a clinic and data on anthropometry, lifestyle factors, fasting biochemical profile, abdominal ultrasonography and liver span was collected. Results: Waist circumference and waist stature ratio (WSR) was higher in grade 3 steatosis compared to grade 1 and grade 2 steatosis. All the subjects with grade 3 steatosis were obese, had abdominal obesity and had significantly lower total MET minutes/week from grade 1 (154 vs. 1267.3, P 0.011) and grade 2 steatosis (154 vs. 663.5, P 0.00006). The lipid fractions increased nonsignificantly from grade 1 to grade 3 steatosis. Gamma glutamyl transferase was significantly higher in grade 3 steatosis compared to grade 1 steatosis (47.1 vs. 30.4 U/L, P 0.020). Grade 3 steatosis subjects had significantly higher liver span than those with grade 1 (188.8 vs. 168.4 mm, P 0.045) and grade 2 steatosis (188.8 vs. 174.1 mm, P 0.029). Prevalence of metabolic syndrome increased steadily; 60% in grade 1 steatosis, 72.4% in grade 2 steatosis and 100% in grade 3 steatosis. WSR (R 2 0.127, F change 10.4, P 0.002) was the predictor of severity of NAFLD based on forward regression analysis. Conclusions: Subjects with grade 3 steatosis had the most unfavorable cardio-metabolic profile warranting earliest intervention to manage and avert NAFLD associated complications.
The Burden of NAFLD and Its Characteristics in a Nationwide Population with Type 2 Diabetes
Journal of Diabetes Research, 2016
Objective. We studied the prevalence of nonalcoholic fatty liver disease (NAFLD) and its clinical correlates in a population of patients with type 2 diabetes mellitus (T2DM).Methods. Clinical data of 94,577 T2DM patients were retrieved from 160 diabetes clinics in Italy in a standardized format and centrally analyzed anonymously. After exclusion of 5967 cases (high or uncertain alcohol intake), in 38,880 the Fatty Liver Index (FLI) was used as a proxy for the diagnosis of NAFLD. Factors associated with FLI assessed NAFLD (FLI-NAFLD) were evaluated through multivariate analysis.Results. FLI-NAFLD was present in 59.6% of patients. Compared to non-NAFLD, FLI-NAFLD was associated with impairment in renal function, higher albumin excretion, HbA1c and blood pressure, lower HDL cholesterol, and poorer quality of care. ALT was within normal limits in 73.6% of FLI-NAFLD patients (45.6% if the updated reference values were used). The prevalence of FLI-NAFLD did not differ if the whole sample ...
Lipid-Lowering Agents in Nonalcoholic Fatty Liver Disease and Steatohepatitis: Human Studies
Digestive Diseases and Sciences, 2012
Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease which refers to the presence of hepatic steatosis without significant intake of alcohol. NAFLD is an asymptomatic disease that can progress to nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma. NAFLD is currently the most common cause of incidental abnormal liver tests and elevated serum liver enzyme activities in the developed world. Obesity, diabetes, and other components of the metabolic syndrome are frequently associated with the NAFLD. The treatment of NAFLD focuses on lifestyle modifications. Statins, fibrates, and other lipid-lowering agents have been proposed as effective lipid-lowering treatments in patients with NAFLD/NASH. However, clinicians are concerned that hyperlipidemic patients with NAFLD/NASH who are treated with statins could develop transaminitis. We assessed the efficacy and safety of lipid-lowering agents for NAFLD/NASH by reviewing reports of human studies including pilot, prospective, preliminary, and post hoc analysis studies on online databases during the period of 1980 to December 2012. The results of studies provide compelling evidence that lipid-lowering agents are safe and efficacious in patients with NAFLD/NASH and that some of these agents can induce a reduction in the extent of the hepatic steatosis. Well-designed randomized controlled studies of adequate size and duration with histological endpoints are needed in order to establish a suitable lipid-lowering treatment for hyperlipidemic patients with NAFLD/NASH, and for nonhyperlipidemic patients with NAFLD/NASH with a high risk for cardiovascular disease.
Atherosclerosis, 2013
Background: Non-alcoholic fatty liver disease (NAFLD) is an emerging disease and a leading cause of chronic liver disease. The prevalence in the general population is approximately 15e30% and it increases to 70e90% in obese or diabetic populations. NAFLD has been linked to increased cardiovascular disease (CVD) risk. It is therefore critical to evaluate the relationship between markers of subclinical CVD and NAFLD. Method: An extensive search of databases; including the National Library of Medicine and other relevant databases for research articles meeting inclusion criteria: observational or cohort, studies in adult populations and clearly defined NAFLD and markers of subclinical CVD. Results: Twenty-seven studies were included in the review; 16 (59%) presented the association of NAFLD and carotid intima-media thickness (CIMT), 7 (26%) the association with coronary calcification and 7 (26%) the effect on endothelial dysfunction and 6 (22%) influence on arterial stiffness. CIMT studies showed significant increases among NAFLD patients compared to controls. These were independent of traditional risk factors and metabolic syndrome. The association was similar in coronary calcification studies. The presence of NAFLD is associated with the severity of the calcification. Endothelial dysfunction and arterial stiffness showed significant independent associations with NAFLD. Two studies argued the associations were not significant; however, these studies were limited to diabetic populations. Conclusion: There is evidence to support the association of NAFLD with subclinical atherosclerosis independent of traditional risk factors and metabolic syndrome. However, there is need for future longitudinal studies to review this association to ascertain causality and include other ethnic populations.
Clinical Profile of Nafld Patients and Its Correlation with Metabolic Syndrome
Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a clinico-pathological entity, increasingly recognised as a major health burden in developed countries and the fastest rising form of chronic liver disease worldwide. It is gaining concern among physicians in developing countries as well as it is predicted that its prevalence may surpass that of chronic hepatitis. It includes a spectrum of liver damage ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), advanced fibrosis and rarely progression to cirrhosis. MATERIALS AND METHODS This was a descriptive study conducted in Department of Medicine, SSMC and SGMH, Rewa. A total of 200 cases were included in the study, who were diagnosed as having fatty liver on the basis of ultrasonography (USG) during the study period of April 2016 to July 2017 and were further investigated for metabolic syndrome. RESULTS Out of 200 cases, 55.5%, 36% and 8.5% of cases had grade I, II and III fatty liver respectively. 128 (64%) had metabolic syndrome. 63.93%, 61.11% and 76.84% of grade I, II and III NAFLD patients suffered from metabolic syndrome respectively. All the components of metabolic syndrome were significantly associated with NAFLD (p ≤ 0.05).
Peripheral artery disease and all-cause and cardiovascular mortality in patients with NAFLD
Journal of Endocrinological Investigation
Purpose Cardiovascular disease (CVD) is the first cause of death in patients with non-alcoholic fatty liver disease (NAFLD) and risk stratification is recommended by current guidelines. The aim of this study is to assess the prevalence of peripheral arterial disease (PAD) in patients with NAFLD and its association with all-cause and cardiovascular disease (CVD) mortality. Methods 9145 participants 40 years or older attended a mobile examination center visit in the 1999–2004 cycles of the National Health and Nutrition Examination Survey. PAD was defined as an ankle-brachial index (ABI) < 0.90 in either of the legs and mortality data through December 2015 were obtained from the National Death Index. NAFLD was defined by a fatty liver index ≥ 60 in the absence of other liver conditions, leading to a final sample of 3094 subjects. Results The overall prevalence of PAD was 5.9% (95% CI 5.0–6.9). Over a median follow-up of 13 years, 876 participants died, 208 of cardiovascular causes. ...
Risk Factors Associated with Type 2 Diabetes Mellitus and the Frequency of Nafld Affected Patients
International Journal of Advanced Research, 2021
Diabetics have a higher risk of developing nonalcoholic fatty liver disease (NAFLD) and associated complications than the general population. The purpose of this study was to determine the prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) in patients with type 2 diabetes, as well as the demographic, metabolic, and biochemical features associated with it. Material and methods: This was a prospective, observational, descriptive (cross-sectional), and non-interventional research on a cohort of type 2 diabetes mellitus patients conducted in a hospital setting. Over the course of 18 months, this study was done (August 2019 to March 2021). Results: A total of 100 patients were enrolled, with 63 (63%) being Females and 64 (37%) being men. Age, BMI, and diabetes duration all had statistically significant positive correlations with the prevalence of nonalcoholic fatty liver disease. Overall prevalence of NAFLD was 63 percent (63/100). In this investigation, gender, age > 48, BMI >...
Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study
BMJ, 2011
Whether nonalcoholic fatty liver disease (nAfLD) is associated with an increased risk of mortality remains controversial. the present study aimed to clarify this issue. A systematic search of pubMed and Embase was conducted through October 2018. Studies providing risk estimates of NAFLD and mortality were included. A random-effects model was employed to calculate summary risk estimates. Subgroup analyses were performed to identify potential effect modifiers. Fourteen studies, involving 498501 subjects and 24234 deaths, were included. Patients with NAFLD were found to be at an elevated risk of all-cause mortality compared with those without [hazard ratio (HR) = 1.34; 95% confidence interval (CI) 1.17-1.54)]. The significantly positive association between NAFLD and all-cause mortality could not be modified by age, sex, follow-up duration, and adjustment for body mass index, diabetes, smoking or hypertension (all P interaction > 0.05), and remained in sensitivity analyses. No significant associations of nAfLD with cVD (HR = 1.13; 95% CI 0.92-1.38) and cancer (HR = 1.05; 95% CI 0.89-1.25) mortality were found. in conclusion, nAfLD is a predictor of increased all-cause mortality but not cVD and cancer mortality. These findings have important implications for decision making in public health and clinical practice, and highlight the urgency of developing effective treatments for NAFLD. Nonalcoholic fatty liver disease (NAFLD) is regarded as the hepatic manifestation of metabolic syndrome, ranging from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH). NAFLD has become a major cause of chronic liver disease worldwide, and is treated as a public health priority. A recent meta-analysis showed that the global prevalence of NAFLD had reached as high as 25.2% 1 , and this number is expected to be 33.5% in 2030 2. Therefore, determining long-term outcomes, including morbidity and mortality, among NAFLD patients has important implications for decision making in public health and clinical practice. In addition to its potential to induce cirrhosis and liver cancer, NAFLD is found to be a well-established risk factor for chronic kidney disease 3 , type 2 diabetes 4 , and cardiovascular disease (CVD) 5. Hence, it is anticipated that NAFLD is a predictor of increased mortality. However, the results from observational studies on NAFLD and mortality remain controversial. Several studies found that patients with NAFLD were at an elevated risk of all-cause mortality compared with those without 6-9 , whereas other studies found no association between NAFLD and mortality 10-13. Moreover, a recent large prospective study found that NAFLD was associated with an increased risk of death from all causes, CVD and cancer in women but not in men 14. Two recent meta-analyses consistently showed that NAFLD was not associated with all-cause mortality 1,15. However, these meta-analyses included only around one-third of studies currently available. More importantly, these meta-analyses pooled data from multiple reports that originated from the same cohort (i.e., the Third National Health and Nutrition Examination Survey cohort, NHANES III) 13,16-18. To our knowledge, a comprehensive meta-analysis focusing on NAFLD and mortality was not available. Therefore, we performed this study to investigate the associations between NAFLD and mortality from all causes, CVD and cancer.