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NAFLD Doubles Risk of CVD and Cuts
up to 6 Years off Life Expectancy
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from Jules: yet PLWH are not getting evaluated for fatty liver, NAFLD & NASH despite that PLWH appear to be at greater risk for these diseases & non-viral hepatitis than the general population. These conditions are not n the radar of PWH nor their clinicians. NAFLD & NASH are comorbidities, they affect PLWH who are aging more as this disease can progress with age. NAFLD can result n cirrhosis & cardiovascular disease may be the most prevalent outcome in people with NAFLD or NASH.
EASL International Liver Congress, June 23-26, 2021
Mark Mascolini
Nonalcoholic fatty liver disease (NAFLD) doubled the risk of cardiovascular disease (CVD) compared with the NAFLD-free general population of Sweden [1]. Among men and women diagnosed with NAFLD at age 40 to 60 in this nationwide study, NAFLD sliced almost 6 years off life expectancy.
Research links NAFLD and the frequently related metabolic syndrome to higher CVD risk. But Karolinska Institute researchers who conducted this study noted that selection bias often taints such studies of CVD risk, and little work compares CVD risk in people with NAFLD versus the general population. The Karolinska team also wondered whether a higher CVD risk with NAFLD lowers life expectancy.
To begin answering these questions, the researchers collected data on everyone with NAFLD in the Swedish National Patient Register from January 1970 through December 2016. They excluded people who already had CVD, those younger than 18, and those with other liver diseases. This left 10,343 people with NAFLD, each of whom the researchers matched by age, sex, and municipality to up to 10 people without NAFLD. This control population included 99,662 individuals.
The investigators used Cox regression models to assess the association of NAFLD or cirrhosis with fatal or nonfatal CVD. Multistate modeling estimated the impact of NAFLD on all-cause mortality after CVD. And flexible parametric relative survival models estimated loss of life expectancy in people with versus without NAFLD.
Compared with the matched general population without NAFLD, Cox regression adjusted for the matching variables plus type 2 diabetes, hypertension, obesity, and dyslipidemia determined that NAFLD doubled the risk of CVD (adjusted hazard ratio [aHR] 2.1, 95% confidence interval [CI] 1.9 to 2.3), while cirrhosis nearly tripled CVD risk (aHR 2.7, 95% CI 1.5 to 4.9). NAFLD approximately tripled the risk of nonfatal CVD (aHR 3.1, 95% CI 2.7 to 3.5), as did cirrhosis (aHR 3.3, 95% CI 1.3 to 5.3). But neither NAFLD nor cirrhosis affected the risk of fatal CVD.
Within the NAFLD group, cirrhosis (vs no cirrhosis) independently boosted risk of CVD 70% (aHR 1.7, 95% CI 1.2 to 2.5) and risk of nonfatal CVD 90% (aHR 1.9, 95% CI 1.2 to 2.9). But cirrhosis did not significantly affect risk of fatal CVD (aHR 1.4, 95% CI 0.7 to 2.7).
NAFLD almost doubled the risk of all-cause death (aHR 1.8, 95% CI 1.7 to 1.9), but nonfatal CVD had no impact on risk of all-cause mortality in this analysis (aHR 0.9, 95% CI 0.6 to 1.3).
NAFLD cut life expectancy by 4.2 years in women (95% CI 1.1 to 7.5) and 4.4 years in men (95% CI 0.2 to 8.5). Among men, years of life lost rose from 5.0 in people diagnosed with NAFLD at 20 to 40 years of age to 5.8 in men diagnosed at 40 to 60. But years of life lost fell to 2.2 in men diagnosed with NAFLD at 60 to 80 years of age and to 0.3 in men diagnosed at 80 or older. Among women, NAFLD took 4.5 years off life expectancy in those diagnosed at 20 to 40 years of age, 5.7 years in women diagnosed at 40 to 60, 2.7 years in women diagnosed at 60 to 80, and 0.3 year in women diagnosed at age 80 or older.
The Karolinska team concluded that NAFLD boosts CVD risk-mainly nonfatal CVD-compared with people without NAFLD, and cirrhosis amplifies that risk. But in people who have a CVD event, NAFLD does not affect death risk. Age at diagnosis of NAFLD "appears to play a role in survival," the researchers suggested, "which can have implications for when to consider a diagnosis of this common disease."
Reference
1. Shang Y, Nasr P, Widman L, Hagstrom H. Life expectancy and risk of cardiovascular disease in non-alcoholic fatty liver disease: a population-based cohort study. EASL International Liver Congress, June 23-26, 2021. Abstract OS-293.
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