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Original investigation
Prognostic Value of Non-alcoholic Fatty Liver Disease in Predicting Cardiovascular Events in Diabetes Mellitus Patients: A Prospective Cohort Study
Toru Miyoshi
Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9039-3439
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Cardiovascular Diabetology.
Background: Risk stratification of cardiovascular events in patients with type 2 diabetes mellitus (T2DM) has not been established. coronary artery calcium score (CACS) and non-alcoholic fatty liver disease (NAFLD) are independently associated with cardiovascular events in T2DM patients. This study examined the incremental prognostic value of NAFLD assessed by non-enhanced computed tomography (CT) in addition to CACS and Framingham risk score (FRS) on cardiovascular events in T2DM patients.
Methods: This prospective pilot study included 529 T2DM outpatients without history of cardiovascular disease who underwent CACS measurement due to suspected coronary artery disease. NAFLD was defined on CT images as a hepatic: spleen attenuation ratio <1.0. cardiovascular events were defined as cardiovascular death, nonfatal myocardial infarction, late coronary revascularization, nonfatal stroke, or hospitalization for heart failure.
Results: Of 529 patients (61% men, mean age 65 years), NAFLD was identified in 143 (27%). During the median 4.4 years of follow-up, 44 cardiovascular events were documented. In multivariate Cox regression analysis, the presence of NAFLD, CACS and FRS were associated with cardiovascular events with hazard ratios of 5.45 (95% confidential interval [CI]: 2.84–10.45; p<0.001), 1.56 (95% CI: 1.32–1.85; p<0.001), and 1.23 (95% CI: 1.08–1.39; p=0.001), respectively. The global chi-square score for predicting cardiovascular events significantly increased from 27.0 to 49.7 by adding NAFLD to CACS and FRS (p<0.001). The addition of NAFLD to a model including CACS and FRS significantly increased the C-statistic from 0.71 to 0.80 (p=0.005). The net reclassification achieved by adding CACS and FRS was 0.551 (p<0.001).
Conclusions: NAFLD assessed by CT, in addition to CACS and FRS, could be useful in assessing T2DM patients at higher risk of cardiovascular events.
Keywords
cardiovascular disease, computed tomography, coronary artery calcium, non-alcoholic fatty liver disease, risk stratification
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CURRENT STATUS: Published
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On 07 Jan, 2021
Published
On 07 Jan, 2021
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Editorial decision: Major Revision
On 18 Oct, 2020
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Received 17 Oct, 2020
Review #1 received
Received 14 Oct, 2020
Reviewer #3 agreed
On 25 Sep, 2020
Reviewer #2 agreed
On 23 Sep, 2020
Reviewers invited
Invitations sent on 23 Sep, 2020
Reviewer #1 agreed
On 23 Sep, 2020
Editor assigned
On 22 Sep, 2020
Editor invited
On 21 Sep, 2020
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On 19 Sep, 2020
First submitted
On 11 Sep, 2020
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This preprint is under consideration at Cardiovascular Diabetology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Original investigation
Prognostic Value of Non-alcoholic Fatty Liver Disease in Predicting Cardiovascular Events in Diabetes Mellitus Patients: A Prospective Cohort Study
Toru Miyoshi
Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9039-3439
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 1
Posted 22 Sep, 2020
Published
On 07 Jan, 2021
Published
On 07 Jan, 2021
No community comments so far
Editorial decision: Major Revision
On 18 Oct, 2020
Review #2 received
Received 17 Oct, 2020
Review #1 received
Received 14 Oct, 2020
Reviewer #3 agreed
On 25 Sep, 2020
Reviewer #2 agreed
On 23 Sep, 2020
Reviewers invited
Invitations sent on 23 Sep, 2020
Reviewer #1 agreed
On 23 Sep, 2020
Editor assigned
On 22 Sep, 2020
Editor invited
On 21 Sep, 2020
Submission checks complete
On 19 Sep, 2020
First submitted
On 11 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Cardiovascular Diabetology.
Background: Risk stratification of cardiovascular events in patients with type 2 diabetes mellitus (T2DM) has not been established. coronary artery calcium score (CACS) and non-alcoholic fatty liver disease (NAFLD) are independently associated with cardiovascular events in T2DM patients. This study examined the incremental prognostic value of NAFLD assessed by non-enhanced computed tomography (CT) in addition to CACS and Framingham risk score (FRS) on cardiovascular events in T2DM patients.
Methods: This prospective pilot study included 529 T2DM outpatients without history of cardiovascular disease who underwent CACS measurement due to suspected coronary artery disease. NAFLD was defined on CT images as a hepatic: spleen attenuation ratio <1.0. cardiovascular events were defined as cardiovascular death, nonfatal myocardial infarction, late coronary revascularization, nonfatal stroke, or hospitalization for heart failure.
Results: Of 529 patients (61% men, mean age 65 years), NAFLD was identified in 143 (27%). During the median 4.4 years of follow-up, 44 cardiovascular events were documented. In multivariate Cox regression analysis, the presence of NAFLD, CACS and FRS were associated with cardiovascular events with hazard ratios of 5.45 (95% confidential interval [CI]: 2.84–10.45; p<0.001), 1.56 (95% CI: 1.32–1.85; p<0.001), and 1.23 (95% CI: 1.08–1.39; p=0.001), respectively. The global chi-square score for predicting cardiovascular events significantly increased from 27.0 to 49.7 by adding NAFLD to CACS and FRS (p<0.001). The addition of NAFLD to a model including CACS and FRS significantly increased the C-statistic from 0.71 to 0.80 (p=0.005). The net reclassification achieved by adding CACS and FRS was 0.551 (p<0.001).
Conclusions: NAFLD assessed by CT, in addition to CACS and FRS, could be useful in assessing T2DM patients at higher risk of cardiovascular events.
Figure 1
Figure 2
Figure 3