97-OR: Fatty Liver Index (FLI) Is an Independent Risk Factor for All-Cause Mortality and Cardiovascular Events in Type 1 Diabetes (T1D) : A 10-Year Observational Study

Abstract

Nonalcoholic fatty liver disease (NAFLD) increases overall and CVD mortality. We prospectively observed 774 T1D to assess impact of FLI (based on BMI, waist, GGT and triglycerides) on all-cause death and CVD (MI, stroke, amputation, revascularizations) risk. Over a 11-year follow-up, 57 subjects died (7.4%) and 49 CV events (6.7%) occurred among 736 T1D with retrievable incidence data. FLI was <30 in 515 T1D (66.5%) , ≥30-60 in 169 (21.8%) , ≥60 in 90 (11.6%) . Mortality increased with FLI: 3.9, 10.1, 22.2% (K-M p<0.0001) . In unadjusted Cox, risk of death in FLI ≥30-60 (HR 2.85, 95% CI 1.49-5.45, p=0.002) and in FLI ≥60 (6.07, 3.27-11.29, p<0.0001) increased respect to FLI <30. Adjusting for Steno Type 1 Risk Engine (ST1-RE: age, sex, DD, sBP, LDL-chol, A1c, ACR, GFR, smoking and exercise) , HRs was 1.52 (0.78-2.97, p=0.222) for FLI ≥30-60 and 3. (1.59-5.82, p=0.001) for FLI ≥60. Inclusion of prior CVD modified HRs slightly. FLI effect was confirmed in 733 T1D without prior CVD (noCVD) . Adjusting for EURODIAB Risk Engine (EURO-RE: age, A1c, WHR, ACR and HDL-chol) did not alter FLI effect (≥30-60: HR 1.24, 0.62-2.48; ≥60: 2.54, 1.30-4.95, p=0.007) even after inclusion of prior CVD, or by restricting the analysis to noCVD subjects. CVD incidence events increased with FLI: 3.5, 10.5, 17.2% (K-M p<0.0001) . In unadjusted Cox, HR was 3.24 (1.65-6.34, p=0.001) for FLI ≥30-60 and 5.41 (2.70-10.83, p<0.0001) for ≥60. After ST1-RE adjustment, HRs was 1.80 (0.90-3.61, p=0.096) for FLI ≥30-60 and 2.98 (1.45-6.13, p=0.003) for FLI ≥60, with trivial modification with prior CVD inclusion. FLI was not a significant predictor in noCVD subjects. EURO-RE adjustment instead of ST1-RE confirmed an independent FLI role (≥30-60: 1.49, 0.73-3.03; ≥60: 2.44, 1.1-5.09, p=0.017) , even after inclusion of prior CVD. This is the first prospective study to demonstrate that FLI is associated with higher all-cause mortality and increased risk of incident CV events in T1D. Disclosure M.Garofolo: Employee; Eli Lilly and Company. D.Lucchesi: None. E.Gualdani: None. P.Falcetta: Speaker's Bureau; Abbott Diabetes. M.Giambalvo: None. P.Francesconi: None. S.Del prato: Advisory Panel; Applied Therapeutics, Eli Lilly and Company, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Sanofi, Consultant; Menarini Group, Research Support; AstraZeneca, Boehringer Ingelheim International GmbH, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck & Co., Inc., Sanofi, Stock/Shareholder; Novo Nordisk A/S. G.Penno: Advisory Panel; Eli Lilly and Company.