Degree of Estimated Fibrosis in Asymptomatic Subjects With Non-Alcoholic Fatty Liver Disease Correlates With Higher Cardiovascular Risk

Abstract

Introduction: Our aim is to assess the estimated 10-year atherosclerotic cardiovascular (ASCVD) risk scores in patients with NAFLD according to the degree of estimated fibrosis by Non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS). Methods: Cross-sectional observational study from a single center in Mexico conducted as a case control analysis in asymptomatic outpatients. NAFLD cases were defined by a positive ultrasound. Estimated 10-year ASCVD risk was calculated with the 2013 American College of Cardiology and the American Heart Association (2013 ACC/AHA) risk equation, Framingham risk score for coronary heart disease (FRS-CHD). High ASCVD risk was defined according to standardized cutoff points: for 2013 ACC/AHA (>= 7.5%) and Framingham (> =20%). NFS was stratified according to the following cut-off points into three groups with progressive degree of fibrosis (<-1.455: F0-F2, >=-1.455-≤ 0.675: indeterminate score, >0.675: F3-F4 fibrosis). Results: We included data from 141 patients with NAFLD by ultrasound and 354 healthy controls. 62% were males, BMI of 25.9 (SD ± 3.9) Kg/m2, 45 (SD ± 11.5) years old. We previously excluded patients with significant alcohol consumption (defined by >30 gr/day in men, >20 g/day in women). NAFLD vs. controls patients had higher mean cardiovascular risk assesed by FRS and 2013 ACC/AHA with 7.1 vs 4.1%(p=0.05) and 5.7 vs 4.4% (p=0.05), respectively, additionally a selected cutoff point for FRS (=>10%) showed a strong association with NAFLD [OR = 5.05 (95% CI 2.1 - 11.9, p < 0.01)]. Global 10-year ASCVD risk was in the case group: for ACC/AHA 5.8% (CI: 95% 4.6-6.9), FRS-CHD 7.2% (CI: 95% 6.1-8.2). Higher degree of fibrosis by NFS correlated with higher FRS risk with a median of 3.5 (RIQ 1.3-7.5), 3.9 (RIQ 2.0-5.7), 8.7 (RIQ 5.3-13.1), for NFS cut-off points F0-F2, indeterminate score, F3-F4 fibrosis, respectively (p < 0.01). High cardiovascular risk estimated for FRS was strongly associated with F3-F4 fibrosis [OR = 9.8 (95% CI 1.17 - 81, p=0.011)]. Total NFS and FRS scores showed correlation with a spearman's Rho of 0.49, (p < 0.001).Figure: Comparison between estimated 10-year risk by Framingham score and NAFLD fibrosis score in patients with ultrasonographic fatty liver disease (n=141).Conclusion: NAFLD patients have higher ASCVD risk than healthy subjects. Higher estimated fibrosis by NAFLD score correlated with higher 10-year ASCVD risk in asymptomatic patients with ultrasonographic fatty liver disease. Presence of higher estimated NFS in fatty liver disease should prompt cardiovascular risk assessment and intervention.