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Multidisciplinary NAFLD Approach Yields Strong CVD Risk Gains
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EASL 2020, Digital International Liver Congress, August 27-29, 2020
Mark Mascolini
A multidisciplinary approach emphasizing consultation and counseling for liver disease, cardiovascular risk, and diet improved cardiovascular disease (CVD) and liver-related risk factors in a 273-person cohort with nonalcoholic fatty liver disease (NAFLD) [1]. Liver markers, blood pressure, cholesterol, and glycated hemoglobin improved significantly through 18 months of follow-up.
Guidelines stress the importance of a multidisciplinary approach in caring for people with NAFLD. Because scant data support that advice, researchers at London's Royal Free Hospital and collaborators at other centers conducted this longitudinal study of NAFLD patients. The researchers prospectively collected data on people referred to a multidisciplinary NAFLD clinic. Care included liver disease consultation, cardiovascular risk assessment, and dietary counseling. In unselected patients with NAFLD, cardiovascular disease leads all causes of death. Cutting CVD risk was a major goal of this multidisciplinary intervention.
Of the 273 NAFLD patients analyzed, 57% were men and age averaged 56.4 years. Half or more of these people had diabetes (50%), obesity (60%), or hypertension (67%). More than 1 in 10 (13%) had a history of cardiovascular events. The investigators determined that 64 people (25%) had initially suboptimal dyslipidemia management, 57 (42%) had suboptimal diabetes management, and 36 (20%) had inadequate hypertension management.
Through 18 months of follow-up, the study group had significant improvement in liver markers (ALT 48 to 43.5 U/L, P = 0.013; AST 34 to 30 U/L, P = 0.013), systolic blood pressure (142 to 137 mm Hg, P = 0.002), diastolic blood pressure (85 to 82 mm Hg, P = 0.014), total cholesterol (4.91 to 4.42 mmol/L, P = 0.000), and LDL cholesterol (2.76 to 2.34 mmol/L, P = 0.000). In people with diabetes, glycated hemoglobin improved from 70.2 to 62.5 mmol/mol (P = 0.04).
Among the 36 people with inadequate hypertension care, average blood pressure dropped from 157/92 mm Hg to 143/86 mm Hg. Among 53 people with poor diabetes management, HbA1c slipped from 68.6 to 62.5 mmol/mol. In addition, clinicians identified another 14 people (11%) with undiagnosed diabetes. Among one quarter of patients who had their lipid therapy changed, 81% achieved the primary prevention LDL goal (below 3 mmol/L) and 83% achieved the secondary prevention LDL goal (below 2 mmol/L).
Of the 273 study participants, 142 (52%) attained weight loss of at least 10% (8.2%), at least 7% (6%), or at least 5% (7.3%). Participants with a QRISK3 score at or above 10% fell from 156 (62.7%) to 97 (48.5%). Among people who had at least one therapeutic intervention, average QRISK3 score dropped from 17.2% to 13.7%. (QRISK3 estimates risk of heart attack or stroke over the next 10 years [2].)
The researchers conclude that multidisciplinary NAFLD management improves liver and cardiovascular risk factors. "A strong collaboration between primary and secondary care," they add, "is essential to implement and maintain these improvements in the long term."
References
1. Mantovani A, Goyale A, Roccarina D, et al. A multidisciplinary approach to non-alcoholic fatty liver disease (NAFLD) improves cardiovascular risk factors. EASL 2020, Digital International Liver Congress, August 27-29, 2020. Abstract AS160.
2. Welcome to the QRISKŪ3-2018 risk calculator. https://qrisk.org/three/
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