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High cardiovascular risk is associated with the degree of fibrosis in non alcoholic fatty liver disease

Session Poster Session 2

Speaker David Niederseer

Event : ESC Congress 2018

  • Topic : preventive cardiology
  • Sub-topic : Prevention – Cardiovascular Risk Assessment: Scores
  • Session type : Poster Session

Authors : D Niederseer (Zurich,CH), A Stadlmayr (Oberndorf,AT), U Huber-Schoenauer (Oberndorf,AT), D Lederer (Oberndorf,AT), CM Schmied (Zurich,CH), M Ploederl (Salzburg,AT), E Aigner (Salzburg,AT), W Patsch (Salzburg,AT), C Datz (Oberndorf,AT)

D. Niederseer1 , A. Stadlmayr2 , U. Huber-Schoenauer2 , D. Lederer2 , C.M. Schmied1 , M. Ploederl3 , E. Aigner3 , W. Patsch3 , C. Datz2 , 1University Hospital Zurich, Department of Cardiology - Zurich - Switzerland , 2General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Department of Internal Medicine - Oberndorf - Austria , 3Paracelsus Private Medical University - Salzburg - Austria ,

European Heart Journal ( 2018 ) 39 ( Supplement ), 296-297

Background: Many patients with non alcoholic fatty liver disease (NAFLD) simultaneously suffer from cardiovascular diseases and often carry multiple cardiovascular risk factors. Several cardiovascular risk factors are known to drive the progression of fibrosis in NAFLD.

Purpose: To investigate whether established cardiovascular risk scores such as the Framingham risk score (FRS) and the Heart Score of the European Society of Cardiology (HS) are associated with the degree of fibrosis in NAFLD in a large screening cohort.

Methods: We screened 2138 asymptomatic subjects (59.6±10.2 years, 50% males, BMI 27.2±4.6 kg/m2). The diagnosis of NAFLD was labeled if 1. (Areas of significant increased echogenicity in relation to the renal parenchyma present in right upper quadrant ultrasound) and 2. (Exclusion of viral, autoimmune, hereditary [Wilson's disease, HFE-associated hereditary hemochromatosis, alpha-1 antitrypsin deficiency] liver disease and excess alcohol consumption evaluated by a questionnaire [cut-off >20g/d]) was fulfilled. The FRS (aims to estimate the ten-year risk of developing coronary heart disease) and HS (aims to estimate ten-year risk of fatal cardiovascular disease) were calculated for each subject, as were NAFLD Fibrosis Score (NFS) and Fibrosis 4 Score (Fib4). Subsequently, NFS, Fib4, FRS and HS were correlated.

Results: Of 2138 subjects, 829 (38.7%) had NAFLD. Patients with NAFLD had a significantly higher cardiovascular risk: FRS: no NAFLD: 5.5±5.2%; NAFLD: 8.8±6.5% (p<0.001); HS: no NAFLD: 2.9±3.8%; NAFLD: 3.7±4.1% (p=0.002). Patients with NAFLD were grouped into three groups according their NFS: F0-F2 (n=663); indifferent (n=155); F3-F4 (n=11). In patients with F0-F2 according to NFS, FRS was 8.0±6.1%; with indifferent NFS, 10.8±6.4%; and in F3-F4 (NFS): 11.5±5.2%, respectively. HS showed a similar pattern: F0-F2 (NFS): 3.0±3.4%; with indifferent NFS, 5.4±4.5%, and in F3-F4 (NFS): 7.0±5.7%, respectively. NFS correlated significantly with FRS (r=0.18, p<0.001) and HS (r=0.27, p<0.001). Likewise, patients with NAFLD were grouped into three groups according to their Fib4: F0-F1 (n=589); indifferent Fib4 (n=411); F3-F4 (n=58). In patients with F0-F1 according to Fib4, FRS was 7.3±5.8%; with indifferent Fib4, 11.1±6.7%; and in F3-F4 (Fib4): 11.1±6.9% respectively. HS did not change with respect to Fib4 estimated degree of fibrosis: F0-F1 (Fib4), 3.2±3.6%; with indifferent Fib4, 3.3±3.8%, and in F3-F4 (Fib4): 2.9±3.9%, respectively. Fib4 correlated with FRS (r=0.25, p<0.001), but not with HS (r=0.02, p=0.55).

Conclusions: In this large asymptomatic screening cohort, subjects with non-invasive indicators of advanced stages of NAFLD had an increased risk of coronary heart disease and cardiovascular outcomes. A multidisciplinary approach including hepatologists and cardiologists is important to ensure optimal care for these patients at high risk of CVD and liver-related endpoints.

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