Abstract
BackgroundNonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic disease and independently affects the development of cardiovascular (CV) disease. We investigated whether hepatic steatosis and/or fibrosis are associated with the development of incident heart failure (iHF), hospitalized HF (hHF), mortality, and CV death in both the general population and HF patients.MethodsWe analyzed 778,739 individuals without HF and 7445 patients with pre-existing HF aged 40 to 80 years who underwent a national health check-up from January 2009 to December 2012. The presence of hepatic steatosis and advanced hepatic fibrosis was determined using cutoff values for fatty liver index (FLI) and BARD score. We evaluated the association of FLI or BARD score with the development of iHF, hHF, mortality and CV death using multivariable-adjusted Cox regression models.ResultsA total of 28,524 (3.7%) individuals in the general population and 1422 (19.1%) pre-existing HF patients developed iHF and hHF respectively. In the multivariable-adjusted model, participants with an FLI ≥ 60 were at increased risk for iHF (hazard ratio [HR], 95% confidence interval [CI], 1.30, 1.24–1.36), hHF (HR 1.54, 95% CI 1.44–1.66), all-cause mortality (HR 1.62, 95% CI 1.54–1.70), and CV mortality (HR 1.41 95% CI 1.22–1.63) in the general population and hHF (HR 1.26, 95% CI 1.21–1.54) and all-cause mortality (HR 1.54 95% CI 1.24–1.92) in the HF patient group compared with an FLI < 20. Among participants with NAFLD, advanced liver fibrosis was associated with increased risk for iHF, hHF, and all-cause mortality in the general population and all-cause mortality and CV mortality in the HF patient group (all p < 0.05).ConclusionHepatic steatosis and/or advanced fibrosis as assessed by FLI and BARD score was significantly associated with the risk of HF and mortality.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic disease and inde‐ pendently affects the development of cardiovascular (CV) disease
Hepatic steatosis based on fatty liver index (FLI) and the incidence of heart failure (HF) and mortality in the general population During the median follow-up period of 8.5 years, 28,524 (3.7%) individuals developed incident heart failure (iHF), 12,484 (1.6%) developed hospitalized HF (hHF), 25,667 (3.3%) experienced all-cause death, and 3074 (0.4%) subjects experienced CV death among a total of 778,739 subjects
As compared with participants without advanced hepatic fibrosis, those with advanced hepatic fibrosis were significantly more likely to experience all-cause death and CV mortality, even after adjusting for multiple covariates, but hHF was not associated with advanced hepatic fibrosis. In this nationwide, large population-based cohort study with a median follow-up period of 8 years, we evaluated the association of hepatic steatosis and/or advanced hepatic fibrosis using FLI and BARD score with iHF, hHF, all-cause mortality, and CV mortality among participants without HF as well as those with pre-existing HF
Summary
Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic disease and inde‐ pendently affects the development of cardiovascular (CV) disease. Several studies reported that imaging- or biopsyproven NAFLD/nonalcoholic steatohepatitis (NASH) was associated with subclinical changes to myocardial structure and/or function [12,13,14] These structural or functional changes of the myocardium are thought to plan an important role in the progression of heart failure (HF); several cross-sectional studies revealed hepatic steatosis and fibrosis to be associated with clinically diagnosed HF [15, 16]. The fatty liver index (FLI), a surrogate marker of fatty liver, was validated in large population including Koreans [17, 18] and BARD score was developed to exclude advanced liver fibrosis in patients with NAFLD in the United States; its effectiveness was previously validated among Asians [19, 20]. The association of hepatic fibrosis defined using BARD score with HF outcomes and mortality has not been evaluated for those patients
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