Abstract
BACKGROUND AND AIM: Non-alcoholic fatty liver disease (NAFLD) and cardio-vascular diseases (CVD) share commonmetabolic risk factors. Despite reports from the clinical setting, association of NAFLD with cardio-vascular diseases and cardio-vascular mortality (CVM) at the population level remains unclear. METHODS: The Nutrition Examination Survey III (NHANES III) conducted between 1988 and 1994 with linked hepatic ultrasound and mortality data were used. Participants were classified into those with NAFLD (moderate or severe hepatic steatosis on the ultrasound without any evidence of other liver disease) and non-NAFLD controls (absence of NAFLD and other chronic liver diseases). The prevalence of CVD was compared between those with and without NAFLD and NAFLD subgroups (based on liver enzymes). Independent predictors of both CVD and CVM were studied as well. RESULTS: Of all eligible adult NHANES III participants, 2,492 individuals (18.77±0.76%) had radiologic NAFLD and of those, 426 (15.86±1.15%) had elevated liver enzymes. During the follow-up (median 171 months), 12.21% of the population died and 3.76% were CVM. Regardless of elevation of liver enzymes, individuals with NAFLD were older, predominantly male, more likely Hispanic and less likely African-American (all pvalue <0.05). They also had higher prevalence of all components of metabolic syndrome and CVD (P<0.05). Furthermore, regardless of liver enzymes, NAFLD was found to be independently associated with CVD after adjustment for major demographic, clinical and metabolic confounders [OR = 1.23 (1.04-1.44)]. Nevertheless, the independent association of NAFLD with CVM remained statistically not significant. CONCLUSIONS: Non-alcoholic fatty liver disease is independently associated with an increased risk of cardiovascular diseases. However, association with cardiovascular mortality was not found after ~14 years of follow-up.
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