Serum Cardiac Biomarkers May Indicate Increased Risk for Severe Coronary Artery Disease Among Patients With Nonalcoholic Fatty Liver Disease

Researchers assessed cardiac biomarkers, among other clinical factors, associated with severe CAD in patients with NAFLD.

The following article is a part of conference coverage from the Digestive Disease Week 2021 Annual Meeting , held virtually from May 21 to 23, 2021. The team at Gastroenterology Advisor will be reporting on the latest news and research conducted by leading experts in gastroenterology. Check back for more from DDW 2021.


Elevated serum high-sensitivity cardiac troponin I (hs-cTnI) among patients with nonalcoholic fatty liver disease (NAFLD) may be a biomarker for severe coronary artery disease (CAD). These findings were presented during the Digestive Disease Week annual meeting, held virtually, from May 21-23, 2021.

Patients (N=517) undergoing cardiac angiography at the Inova Health System in the United States were prospectively recruited for this study. Patients underwent cardiac biomarker screening and an abdominal ultrasound with transient elastography.

Normal cardiac biomarker cut-offs were 3 mg/L for high-sensitivity C-reactive protein (hsCRP), 125 pg/mL for N-terminal pro-brain natriuretic peptide (NT-proBNP), and 5 ng/L for hs-cTnI. NAFLD was defined as the presence of hepatic fat in the absence of liver disease and severe CAD as ³1 vessel with >70% stenosis or an atherosclerotic cardiovascular disease score ³20.

Patients were aged mean 63±10 years, 80% were men, 78% had hyperlipidemia, 75% hypertension, 30% type 2 diabetes mellitus, and body mass index (BMI) was 29.9±5.7 kg/m2.

NAFLD was observed among 63% of patients and severe CAD among 57%.

Stratified by CAD status, patients with severe CAD were older (mean, 66 vs 59 years; P <.01), more were men (88% vs 69%; P <.01), had hyperlipidemia (88% vs 65%; P <.01), hypertension (83% vs 64%; P <.01), diabetes (42% vs 14%; P <.01), elevated NT-proBNP (56% vs 36%; P <.01), and hs-cTnI (61% vs 41%; P <.01).

Severe CAD was associated with male sex (odds ratio [OR], 4.92; 95% CI, 2.83-8.54; P <.05), diabetes (OR, 4.27; 95% CI, 2.51-7.26; P <.05), hyperlipidemia (OR, 2.46; 95% CI, 1.45-4.17; P <.05), elevated NT-proBNP (OR, 1.98; 95% CI, 1.27-3.08; P <.05), hypertension (OR, 1.70; 95% CI, 1.04-2.79; P <.05), and older age (per year: OR, 1.09; 95% CI, 1.06-1.11; P <.05).

NAFLD rates were similar among the CAD and non-CAD cohorts (64% vs 62%; P =.73), respectively.

Among patients with NAFLD, 58% had severe CAD. The NAFLD severe CAD comorbid group had more elevated hs-cTnI (57% vs 37%; P <.02) and NT-proBNP (48% vs 33%%; P <.02) compared with NAFLD alone.

Severe CAD among the patients with NAFLD was associated with hyperlipidemia (OR, 3.63; 95% CI, 1.75-7.54; P <.02), diabetes (OR, 3.52; 95% CI, 1.85-6.68; P <.02), male sex (OR, 3.23; 95% CI, 1.51-6.93; P <.02), elevated hs-cTnI [OR, 1.96; 95% CI, 1.12-3.42; P <.02), and older age (per year: OR, 1.10; 95% CI, 1.07-1.14; P <.02).

The association between NAFLD, severe CAD, and elevated hs-cTnI requires additional validation.

These data indicated that hs-cTnI could be a valuable biomarker for severe CAD among patients with NAFLD.

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Lam BP, Jeffers T, Felix SC, et al. Cardiac serum biomarkers predicting severe coronary artery disease (CAD) among patients with non-alcoholic fatty liver disease (NAFLD). Poster presented at: Digestive Disease Week Annual Meeting; May 21-23, 2021. Abstract Sa351.