Non-alcoholic steatohepatitis and hepatic fibrosis are strongly associated with estimated 10-years cardiovascular risk in people living with severe obesity

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Cardiometabolic health, diabetes and obesity research network IUCPQ Foundation. Background Obesity (Body Mass Index [BMI] over 30 kg/m2) is associated with metabolic disturbances that promote the development and progression of cardiovascular diseases (CVD). However, the association between anthropometric indices of obesity (BMI, Waist Circumference [WC], Waist-to-Hip ratio [WHR] or Neck Circumference [NC]) and CVD risk factors has not always been observed in people living with severe obesity (BMI >35 kg/m2). Among obesity-related metabolic disorders, non-alcoholic ateatohepatitis (NASH) is associated with an increased risk of CVD and cardiac events. NASH has been shown to correlate with a degree of obesity, as defined by BMI or WC. The association between anthropometric parameters, NASH and CVD risk factors has not been explored yet in people living with severe obesity. Purpose The aim of this study was to explore the relationships between CVD risk score, anthropometric parameters and the presence of NASH (hepatic steatosis and fibrosis) in a population with severe obesity. Method A total of 2257 patients with severe obesity, who underwent bariatric surgery with concomitant liver biopsy were included. All biopsy specimens were classified according to the Brunt grading system. Pre-operative demographic and anthropometric data (age, sex, weight, height, BMI, WC, WHR, NC) were recorded. Comorbidities were assessed (type 2 diabetes, hypertension, dyslipidemia). The 10-year cardiovascular risk was calculated preoperatively in each patient using the Framingham risk score (FRS). Dependent variable FRS was compared using Kruskal Wallis H test and Chi2 exact test. Associations were tested using multivariate logistic regression analysis. Results In this specific population (mean age of 46.2 years old, mean BMI of 47.8 kg/m2, 69.1% female), FRS did not significantly increase with weight, BMI and WC, but was positively correlated with WHR and NC (p<0.05). A total of 47.3 % of patients with a histopathological diagnosis of NASH had a moderate-to-high FRS. Among NASH patients with histopathological evidence of grade-4 fibrosis, 69.3% had a moderate-to-high FRS. Presence of NASH and fibrosis were more strongly correlated with a moderate-to-high FRS (OR of 1.61 and 1.37, respectively), compared to all other anthropometric parameters (p<0.05), except WHR (OR of 1.99). Conclusion In people living with severe obesity, the presence of NASH and hepatic fibrosis is strongly associated with a high FRS but not more than WHR. Further research is needed to identify the best predictors of CVD and cardiac events in people living with NASH and severe obesity.