Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: A meta-analysis

被引:1012
作者
Targher, Giovanni [1 ,2 ]
Byrne, Christopher D. [3 ,4 ]
Lonardo, Amedeo [5 ,6 ]
Zoppini, Giacomo [1 ,2 ]
Barbui, Corrado [7 ]
机构
[1] Univ Verona, Dept Med, Sect Endocrinol Diabet & Metab, Piazzale Stefani 1, I-37126 Verona, Italy
[2] Azienda Osped Univ Integrata Verona, Verona, Italy
[3] Univ Southampton, Fac Med, Nutr & Metab, Southampton, Hants, England
[4] Southampton Univ Hosp, Southampton Natl Inst Hlth Res, Biomed Res Ctr, Southampton, Hants, England
[5] Azienda USL, NOCSAE, Dept Biomed Metab & Neural Sci, Div Internal Med, Modena, Italy
[6] Univ Modena & Reggio Emilia, Modena, Italy
[7] Univ Verona, WHO Collaborating Ctr Res & Training Mental Hlth, Sect Psychiat, Verona, Italy
关键词
NAFLD; Cardiovascular disease; CVD events; Mortality; Meta-analysis; GAMMA-GLUTAMYL-TRANSPEPTIDASE; TERM-FOLLOW-UP; NATURAL-HISTORY; ASSOCIATION; MORTALITY; FIBROSIS; OUTCOMES; NAFLD; PROGRESSION; POPULATION;
D O I
10.1016/j.jhep.2016.05.013
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background & Aims: There have been many studies of the effects of non-alcoholic fatty liver disease (NAFLD) and the risk of cardiovascular disease (CVD), but these have produced conflicting results. We performed a meta-analysis of these studies to quantify the magnitude of the association between NAFLD (and NAFLD severity) and risk of CVD events. Methods: We searched PubMed, Google scholar, and Web of Science databases using terms "NAFLD", "cardiovascular events", "cardiovascular mortality", "prognosis" and their combinations to identify observational studies published through January 2016. We included only observational studies conducted in adults > 18 years and in which NAFLD was diagnosed on imaging or histology. Data from selected studies were extracted and meta-analysis was then performed using random effects modelling. Results: A total of 16 unique, observational prospective and retrospective studies with 34,043 adult individuals (36.3% with NAFLD) and approximately 2,600 CVD outcomes (>70% CVD deaths) over a median period of 6.9 years were included in the final analysis. Patients with NAFLD had a higher risk of fatal and/or non-fatal CVD events than those without NAFLD (random effect odds ratio [OR] 1.64, 95% CI 1.26-2.13). Patients with more 'severe' NAFLD were also more likely to develop fatal and non-fatal CVD events (OR 2.58; 1.78-3.75). Sensitivity analyses did not alter these findings. Funnel plot and Egger's test did not reveal significant publication bias. Conclusions: NAFLD is associated with an increased risk of fatal and non-fatal CVD events. However, the observational design of the studies included does not allow to draw definitive causal inferences. Lay summary: The data on whether NAFLD by itself is associated with increased cardiovascular events and death remains an issue of debate. The findings of this updated and large meta-analysis of observational studies indicate that NAFLD is significantly associated with an increased risk of fatal and non-fatal cardiovascular events. However, the observational design of the studies included does not allow us to prove that NAFLD causes cardiovascular disease. Clinicians who manage patients with NAFLD should not focus only on liver disease but should also consider the increased risk of cardiovascular disease and undertake early, aggressive risk factor modification. (C) 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:589 / 600
页数:12
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