Table 1.
Current evidence of the association between NAFLD and CVD.
| Authors, year | Country | Type of study | Main characteristics | NAFLD diagnostic | Results |
|---|---|---|---|---|---|
| Bonnet et al., 2017 [56] | France | Prospective, cohort | 2,565 patients, normotensive, followed up for 9 years | GGT, FLI | GGT was associated with incident hypertension (standardized odds ratio: 1.21; 95% confidence interval (1.10–1.34); P = 0.0001). FLI predicted incident hypertension in a multivariable model. |
| Huh et al., 2015 [57] | South Korea | Prospective, cohort | 1,521 patients, aged 40–70, followed up for 2.6 years | FLI | 10.06% of patients developed hypertension; FLI was associated with baseline blood pressure and was an independent risk factor for hypertension. |
| Lau et al., 2010 [58] | Germany | Prospective, cohort | 3191 patients, aged 20–79, followed up for 11.6 years | US and liver Enzymes | Fatty liver disease was associated with hypertension at baseline and at follow-up, OR 2.8; 95% CI 1.3–6.2 and OR 3.1; 95% CI 1.7–5.8, respectively. |
| Ryoo et al., 2014 [59] | South Korea | Prospective, cohort | 11350 patients, only men, aged 30–59, normotensive, followed up for 5 years | US | 58.2% of the participants developed prehypertension, 63.7% of the patients with mild NAFLD, and 70.3% of the ones with severe NAFLD, P < 0.001. |
| Sung et al., 2014, [60] | South Korea | Retrospective, cohort | 11448 patients, aged 42.1 ± 6.8, normotensive, followed up for 5 years | US | NAFLD was associated with incident hypertension, after adjustment for multiple confounders [aOR = 1.60 (95% CI 1.30, 1.96; P < 0.001)]. |
| Agac et al., 2013 [61] | Turkey | Prospective, cross-sectional | 80 patients with acute coronary syndrome | US | NAFLD was present in 81.2% of the patients with acute coronary syndrome; multivariate analysis found NAFLD to be associated with higher SYNTAX score (OR, 13.20; 95% CI, 2.52–69.15). |
| Agarwal et al., 2011 [62] | India | Prospective, cross-sectional | 124 patients with T2DM | US | CAD was diagnosed in 60.5% of the patients with NAFLD and in 45.2% of the ones without NAFLD. |
| Arslan et al., 2012 [63] | Turkey | Prospective, cross-sectional | 151 patients with newly diagnosed CAD, without T2DM | US | NAFLD was diagnosed in 64.9% of the patients. Presence of NAFLD was associated with poor coronary collateral development. |
| Chan et al., 2014 [64] | Malaysia | Prospective, cross-sectional | 399 diabetic patients, mean age 62.8 ± 10.5 | US | NAFLD was found in 49.6% of patients but was not associated with IHD. |
| Chen et al., 2010 [65] | Taiwan, China | Retrospective, cross-sectional | 295 patients | US, CT | NAFLD (OR, 2.462; 95% CI, 1.065–5.691) was found to be an independent factor for the risk of coronary artery calcifications. |
| Chiang et al., 2010 [66] | Taiwan, China | Retrospective, cross-sectional | 724 patients | US | NAFLD was found to be an independent predictor for future CVD risk ≥10% (OR: 1.89, P = 0.004). |
| Keskin et al., 2017 [67] | Turkey | Retrospective, cohort | 360 patients with STEMI | US | Multivariate analysis found grade 3 NAFLD to be a risk factor for in-hospital mortality (OR 4.2). |
| Perera et al., 2016 [68] | Sri Lanka | Prospective | 120 patients with acute coronary syndrome | US | NAFLD was identified in 46.7% of the participants. NAFLD was associated with a higher predicted in-hospital mortality (adjusted OR 31.3, CI 2.2–439.8, P = 0.011) and at 6 months after discharge (adjusted OR 15.59, CI 1.6–130.6, P = 0.011). |
| Wu et al., 2017 [69] | China | Cross-sectional | 2345 patients | US | NAFLD was significantly associated with the development of coronary artery calcifications (adjusted OR: 1.348, 95% CI: 1.030–1.765). |
| Baratta et al., 2020 [6] | Italy | Prospective | 898 patients, followed up for 41.4 months | US | Patients with NAFLD presented over 2x increase in risk of CVEs; patients with liver fibrosis had a 4x increase in risk. |
| Pastori et al., 2020 [70] | Multicenter | Prospective, cohort | 1735 patients with nonvalvular atrial fibrillation | FLI | NAFLD was diagnosed in 42.2% of the participants but was not associated with bleeding or with thrombotic risk. |
| Alexander et al., 2019 [71] | Multicenter (Italy, Netherlands, Spain, United Kingdom) | Matched cohort study | 120795 patients with NAFLD or NASH | / | NAFLD was not found to be associated with increased risk for acute myocardial infarction. |
NAFLD: nonalcoholic fatty liver disease; FLI: fatty liver index; US: ultrasound; OR: odds ratio; CI: confidence interval; HR: hazard ratio; CAD: coronary artery disease; T2DM: type 2 diabetes mellitus; CAD: coronary artery disease; IHD: ischemic heart disease; CT: computed tomography; CVD: cardiovascular disease; STEMI: ST segment elevation myocardial infarction; CVE: cardiovascular event; NASH: nonalcoholic steatohepatitis.