Increased Risk for Cardiovascular Events in Patients With Nonalcoholic Fatty Liver Disease

Investigators assessed the incidence of major adverse cardiovascular events in patients with histologically-confirmed nonalcoholic fatty liver disease.

Patients diagnosed with nonalcoholic fatty liver disease (NAFLD) had increased incidences of major adverse cardiovascular events (MACE) compared against patients without NAFLD, according to a population-based cohort study published in Gut.

All Swedish patients with histologically-confirmed NAFLD, diagnosed from 1966 to 2016, without cardiovascular disease at baseline were included in the study. The 10,422 patients with NAFLD were then matched based on age, sex, calendar year, and county with up to 5 patients who did not have NAFLD or any cardiovascular disease. Overall, 46,517 control patients were included in the analysis.

The primary outcome was the composite incidence of MACE, which included ischemic heart disease, acute myocardial infarction, congestive heart failure, stroke, or cardiovascular mortality. Secondary outcomes included the incidence of each individual MACE subtype.

Among patients with histologically confirmed NAFLD, the average age at first biopsy was 52 years; 45% of patients were women. Overall, 5.2% of patients with NASH also had cirrhosis. Those diagnosed with NAFLD were more likely to have diabetes, obesity, hypertension, dyslipidemia, chronic kidney disease, and family history of early cardiovascular disease compared with patients in the control group.

After adjusting for confounding disease states such as diabetes, obesity, and family history, investigators found patients with NAFLD were at a 1.63-fold higher risk for a MACE incident compared with non-NAFLD control patients (95% CI, 1.56-1.70). When stratified by severity, event risk increased in concordance with NAFLD severity. While acute myocardial infarction had similar incidences, ischemic heart disease, congestive heart failure, cardiovascular mortality, and stroke were all more likely in patients with NAFLD compared against control patients.

The study included primarily Caucasian patients, which limits the applicability of the results to other regions and populations. Additional studies are needed on a more diverse patient population. Similar to previously completed studies, these results reinforce the need for timely cardiovascular screening in patients with NAFLD.

Disclosure: The authors declared affiliations with biotech, pharmaceutical, and/or device companies. Pleases see the original reference for a full list of author disclosures.


Simon T, Roelstraete B, Hagström H, Sundström J, Ludvigsson J. Non-alcoholic fatty liver disease and incident major adverse cardiovascular events: results from a nationwide histology cohort. Gut. Published online September 11, 2021. doi: 10.1136/gutjnl-2021-325724