Cardiovascular disease and nonalcoholic fatty liver disease: does histologic severity matter?

GOALS: We aimed to investigate the prevalence of cardiovascular disease in patients with nonalcoholic steatohepatitis (NASH) versus non-NASH fatty liver.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular disease, which is a leading cause of death in this patient population. NASH is a subset of NAFLD that carries a higher risk of progression to cirrhosis and its associated complications.

STUDY: We conducted a retrospective chart review of patients with biopsy-confirmed NAFLD, including NASH and non-NASH fatty liver, within the Gastroenterology and Hepatology clinic at Brooke Army Medical Center. Patients with secondary causes of chronic liver disease were excluded. The patients' records were reviewed for the presence of significant cardiovascular disease, which was defined as a history of stroke, unstable angina, myocardial infarction, congestive heart failure, or need for revascularization.

RESULTS: Nine hundred thirteen patients were identified and 377 patients met inclusion and exclusion criteria and were included in the final analysis. Of these, 219 patients had biopsies showing the presence of at least grade I NASH. The overall prevalence of cardiovascular disease was 6.63%. After controlling for age, sex, body mass index, and the presence of diabetes, there was no significant increase in the prevalence of cardiovascular disease in the NASH cohort over the non-NASH group.

CONCLUSIONS: Cardiovascular disease is common among patients with NAFLD. However, no increased risk of cardiovascular disease was found among those patients with NASH as compared with those with non-NASH fatty liver.