Metabolic Dysfunction-Associated Fatty Liver Disease Better Predicts Incident Cardiovascular Disease
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Background/Aims: Metabolic dysfunction (MD)-associated fatty liver disease is a new positive diagnostic criterion based on hepatic steatosis and MD. However, a comprehensive evaluation on the association of MD and hepatic steatosis with incident cardiovascular disease (CVD) has yet to be performed. Methods: This retrospective cohort study included 333,389 participants from the Korean National Health Insurance Service database who received a health examination between 2009 and 2010. Hepatic steatosis was defined using the Korean National Health and Nutrition Examination Survey-derived nonalcoholic fatty liver disease scoring system. Cox proportional hazards regression was adopted to determine the adjusted hazard ratio (aHR) with 95% confidence interval (CI) for CVD according to the presence of hepatic steatosis and MD, as well as the composite term. Results: This study included 179,437 men and 153,952 women with a median age of 57 years. Hepatic steatosis with MD (aHR, 2.00; 95% CI, 1.89 to 2.13) and without MD (aHR, 1.30; 95% CI, 1.10 to 1.54) significantly increased the risk of CVD compared to no steatosis without MD (reference). However, steatosis revealed no significant difference in the risk of CVD compared to no steatosis among participants with one MD (aHR, 1.09; 95% CI, 0.91 to 1.30). In participants with steatosis, the presence of one and ≥2 MDs had aHR values of 1.25 (95% CI, 0.87 to 1.79) and 1.71 (95% CI, 1.22 to 2.41), respectively, compared to no MD. Conclusions: Combined consideration of hepatic steatosis and MD was significantly associated with increased CVD risk and showed better predictive performance for CVD than hepatic steatosis or MD alone.
Abstract
Background/Aims: Metabolic dysfunction (MD)-associated fatty liver disease is a new positive diagnostic criterion based on hepatic steatosis and MD. However, a comprehensive evaluation on the association of MD and hepatic steatosis with incident cardiovascular disease (CVD) has yet to be performed. Methods: This retrospective cohort study included 333,389 participants from the Korean National Health Insurance Service database who received a health examination between 2009 and 2010. Hepatic steatosis was defined using the Korean National Health and Nutrition Examination Survey-derived nonalcoholic fatty liver disease scoring system. Cox proportional hazards regression was adopted to determine the adjusted hazard ratio (aHR) with 95% confidence interval (CI) for CVD according to the presence of hepatic steatosis and MD, as well as the composite term. Results: This study included 179,437 men and 153,952 women with a median age of 57 years. Hepatic steatosis with MD (aHR, 2.00; 95% CI, 1.89 to 2.13) and without MD (aHR, 1.30; 95% CI, 1.10 to 1.54) significantly increased the risk of CVD compared to no steatosis without MD (reference). However, steatosis revealed no significant difference in the risk of CVD compared to no steatosis among participants with one MD (aHR, 1.09; 95% CI, 0.91 to 1.30). In participants with steatosis, the presence of one and ≥2 MDs had aHR values of 1.25 (95% CI, 0.87 to 1.79) and 1.71 (95% CI, 1.22 to 2.41), respectively, compared to no MD. Conclusions: Combined consideration of hepatic steatosis and MD was significantly associated with increased CVD risk and showed better predictive performance for CVD than hepatic steatosis or MD alone.
참고문헌 (31)
- Ludwig J, "Nonalcoholic steatohepatitis : Mayo Clinic experiences with a hitherto unnamed disease", Mayo Clin Proc, 55, pp.434~438 (1980)
- Younossi Z, "Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis", Hepatology, 69, pp.2672~2682 (2019)
- Younossi Z, "Global burden of NAFLD and NASH : trends, predictions, risk factors and prevention", Nat Rev Gastroenterol Hepatol, 15, pp.11~20 (2018)
- Eslam M, "MAFLD : a consensus-driven proposed nomenclature for metabolic associated fatty liver disease", Gastroenterology, 158, pp.1999~2014 (2020)
- Eslam M, "A new definition for metabolic dysfunction-associated fatty liver disease : an international expert consensus statement", J Hepatol, 73, pp.202~209 (2020)
- Stefan N, "Causes, characteristics, and consequences of metabolically unhealthy normal weight in humans", Cell Metab, 26, pp.292~300 (2017)
- Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, "Executive summary of the third report of the National Cholesterol Education Program(NCEP)Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults(Adult Treatment Panel III)", JAMA, 285, pp.2486~2497 (2001)
- European Association for the Study of the Liver (EASL), "EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease", J Hepatol, 64, pp.1388~1402 (2016)
- Chalasani N, "The diagnosis and management of nonalcoholic fatty liver disease : practice guidance from the American Association for the Study of Liver Diseases", Hepatology, 67, pp.328~357 (2018)
- Jeong S, "Development of a simple nonalcoholic fatty liver disease scoring system indicative of metabolic risks and insulin resistance", Ann Transl Med, 8, pp.1414~ (2020)
- Kovalic AJ, "The role of nonalcoholic fatty liver disease on cardiovascular manifestations and outcomes", Clin Liver Dis, 22, pp.141~174 (2018)
- Mottillo S, "The metabolic syndrome and cardiovascular risk a systematic review and metaanalysis", J Am Coll Cardiol, 56, pp.1113~1132 (2010)
- Kwon S, "Thirty years of national health insurance in South Korea : lessons for achieving universal health care coverage", Health Policy Plan, 24, pp.63~71 (2009)
- Seong SC, "Cohort profile : the National Health Insurance Service-National Health Screening Cohort(NHIS-HEALS)in Korea", BMJ Open, 7, pp.e016640~ (2017)
- Choi J, "Risk of hepatocellular carcinoma in patients treated with entecavir vs tenofovir for chronic hepatitis B : a Korean nationwide cohort study", JAMA Oncol, 5, pp.30~36 (2019)
- Bedogni G, "The fatty liver index : a simple and accurate predictor of hepatic steatosis in the general population", BMC Gastroenterol, 6, pp.33~ (2006)
- Kahn HS, "The"lipid accumulation product"performs better than the body mass index for recognizing cardiovascular risk : a population-based comparison", BMC Cardiovasc Disord, 5, pp.26~ (2005)
- Lee JH, "Hepatic steatosis index : a simple screening tool reflecting nonalcoholic fatty liver disease", Dig Liver Dis, 42, pp.503~508 (2010)
- Sundararajan V, "New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality", J Clin Epidemiol, 57, pp.1288~1294 (2004)
- Writing Group Members, "Heart disease and stroke statistics : 2016 update. A report from the American Heart Association", Circulation, 133, pp.e38~e360 (2016)
- Son JS, "Association of blood pressure classification in Korean young adults according to the 2017American College of Cardiology", American Heart Association Guidelines with subsequent cardiovascular disease events, 2018, pp.320, 1783~1792
- Eslam M, "The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease", Hepatol Int, 14, pp.889~919 (2020)
- Seong Hee Kang, "From nonalcoholic fatty liver disease to metabolic-associated fatty liver disease: Big wave or ripple?", Clinical and Molecular Hepatology, 27(2), pp.257~269 (2021), 대한간학회[DOI]
- Kim D, "Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States", Hepatology, 57, pp.1357~1365 (2013)
- Lee H, "Metabolic dysfunctionassociated fatty liver disease and incident cardiovascular disease risk : a nationwide cohort study", Clin Gastroenterol Hepatol, 19, pp.2138~2147 (2021)
- Targher G, "Non-alcoholic fatty liver disease and risk of incident cardiovascular disease : a meta-analysis", J Hepatol, 65, pp.589~600 (2016)
- Fernández-SolàJ, "Cardiovascular risks and benefits of moderate and heavy alcohol consumption", Nat Rev Cardiol, 12, pp.576~587 (2015)
- Goel S, "Effect of alcohol consumption on cardiovascular health", Curr Cardiol Rep, 20, pp.19~ (2018)
- Lo MK, "Effects of gender, Helicobacter pylori and hepatitis B virus serology status on cardiovascular and renal complications in Chinese type 2 diabetic patients with overt nephropathy", Diabetes Obes Metab, 6, pp.223~230 (2004)
- Petta S, "Hepatitis C virus infection is associated with increased cardiovascular mortality : a meta-analysis of observational studies", Gastroenterology, 150, pp.145~155 (2016)
- Wang Y, "Hepatitis B virus and the risk of coronary heart disease : a comprehensive systematic review and meta-analyses of observational studies", Int J Cardiol, 265, pp.204~209 (2018)