Prognostic Value of Non-alcoholic Fatty Liver Disease in Predicting Cardiovascular Events in Diabetes Mellitus Patients: A Prospective Cohort Study
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.
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Posted 22 Sep, 2020
On 07 Jan, 2021
On 07 Jan, 2021
On 18 Oct, 2020
Received 17 Oct, 2020
Received 14 Oct, 2020
On 25 Sep, 2020
On 23 Sep, 2020
Invitations sent on 23 Sep, 2020
On 23 Sep, 2020
On 22 Sep, 2020
On 21 Sep, 2020
On 19 Sep, 2020
On 11 Sep, 2020
Prognostic Value of Non-alcoholic Fatty Liver Disease in Predicting Cardiovascular Events in Diabetes Mellitus Patients: A Prospective Cohort Study
Posted 22 Sep, 2020
On 07 Jan, 2021
On 07 Jan, 2021
On 18 Oct, 2020
Received 17 Oct, 2020
Received 14 Oct, 2020
On 25 Sep, 2020
On 23 Sep, 2020
Invitations sent on 23 Sep, 2020
On 23 Sep, 2020
On 22 Sep, 2020
On 21 Sep, 2020
On 19 Sep, 2020
On 11 Sep, 2020
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