Abstract 12503: Liver Injury is Associated With Total Cardiovascular Disease, Heart Failure, Stroke, Coronary Heart Disease and Acute Myocardial Infarction Including Among Those Without Viral Hepatitis (B Or C), Hiv, Alcohol Abuse and Obesity

Abstract

Introduction: Hepatitis C and human immunodeficiency virus (HCV, HIV) are associated with cardiovascular disease (CVD). Liver injury is common in HIV and HCV and is associated with pro-atherosclerotic conditions e.g. altered coagulation. We assessed whether liver injury independently predicts CVD risk including among participants without major liver-related co-morbidities. Methods: Participants from the Veterans Aging Cohort Study Virtual Cohort (VACS VC), without CVD at baseline (first clinical visit after 4/1/2003) were included. Liver injury was defined by liver fibrosis index 4 at baseline (FIB4 calculated using age, liver transaminases and platelets) and ICD-9 codes for cirrhosis and hepatic decompensation. Total fatal and non-fatal CVD were assessed using 1) National Death Index cause of death data; 2) VA; 3) VA Fee For Service; and 4) Medicare ICD-9 and procedure codes for acute myocardial infarction, heart failure (HF), coronary heart disease (CHD) and stroke. Follow-up ended after a CVD event, or death, or on 9/30/2012. Cox regression analyses were used to estimate the risk of total CVD, HF, stroke, CHD and AMI by liver injury. Results: Mean (SD) age was 49.6 (9.5) years in this cohort (N=104731, 90% male) followed for a median (IQR) of 7 (3, 9) years. LDL cholesterol and BMI decreased with increasing FIB4 while age increased. African American race, HIV, HCV, HBV, current smoking, type 2 diabetes, alcohol abuse, cocaine use and anemia were more common among participants with FIB4 >1.45 compared to those with FIB4 <1.45. Incident CVD rates increased with increasing FIB4. FIB4 >3.25 or a clinical diagnosis of cirrhosis or hepatic decompensation was independently associated with significantly elevated CVD risk. This association persisted in Veterans without HCV, HBV, HIV, alcohol use disorder and BMI >30 kg/m2. Conclusions: Liver injury is associated with increased risk of CVD. Future studies should assess whether FIB4 improves CVD risk prediction algorithms.