Advanced fibrosis, as indicated by noninvasive markers, is associated with increased risk for cardiovascular-related death among patients with nonalcoholic fatty liver disease, according to recent results.
Researchers evaluated data from 11,154 patients enrolled in the 1988-1994 National Health and Nutrition Examination Survey (NHANES III), with follow-up through 2006. Incidence and severity of nonalcoholic fatty liver disease (NAFLD) within the cohort were identified, along with mortality rates.
NAFLD was observed in 34% of the cohort, with a NAFLD fibrosis score (NFS) indicating advanced fibrosis in 3.2% of cases, intermediate fibrosis in 25.1%, and no significant fibrosis in 71.7%. Death occurred in 1,759 cases during follow-up, with cardiovascular issues (9.3%) and malignancy (5.0%) the most common causes. Investigators observed no associations between NAFLD and either overall (adjusted HR=1.05; 95% CI, 0.93-1.19) or cause-specific mortality risk after adjusting for age and sex.
Patients with a high probability of advanced fibrosis were at significantly higher risk for death than those with low probability for fibrosis. This association was observed using NFS (HR=1.69; 95% CI, 1.09-2.63), aspartate aminotransferase to platelet ratio index (APRI) (HR=1.85; 95% CI, 1.02-3.37) and FIB-4 score (HR=1.66; 95% CI, 0.98-2.82) to indicate fibrosis. Nearly all of this risk increase was linked to death from cardiovascular causes (HR=3.46; 95% CI, 1.91-6.25 for NFS measurement, HR=2.53; 95% CI, 1.33-4.83 for APRI and HR=2.68; 95% CI, 1.44-4.99 for FIB-4).
“Clearly, the prevalence of NAFLD is extremely high, which translates to a large aggregate disease burden, be it cardiovascular, diabetes or liver-related,” the researchers wrote. “ … from this and other studies, it is clear that NAFLD without advanced fibrosis has little effect on mortality upon follow-up for up to two decades. However, NAFLD with advanced fibrosis is an independent predictor of increased mortality, mainly from cardiovascular causes. In those patients, rigorous interventions to modify cardiovascular risk factors as well as careful follow-up for progression of fibrosis may be warranted.”