#VisualAbstract: Non-alcoholic fatty liver disease and risk of incident acute myocardial infarction and stroke

1. After adjustment for established cardiovascular risk factors, the diagnosis of non-alcoholic fatty liver disease (NAFLD) does not appear to be associated with risk of acute myocardial infarction or stroke.

Evidence Rating Level: 2 (Good)

Recent studies indicate that non-alcoholic fatty liver disease (NAFLD) is associated with a higher risk of acute myocardial infarction and stroke. However, these studies only partially adjusted for known risk factors of cardiovascular disease, such as diabetes and lipid levels. In this matched retrospective cohort study, 120,795 adults with a diagnosis of NAFLD or non-alcoholic steatohepatitis (NASH) and no other liver diseases were identified from four primary care databases, and matched to 100 controls at the time of NAFLD diagnosis (index date) to study the incidence of fatal or non-fatal acute myocardial infarction (AMI) and ischemic or unspecific stroke. At baseline, traditional cardiovascular risk factors were more common in participants with NAFLD compared with matched controls, including smoking, a history of type 2 diabetes or hypertension, higher BMI and systolic blood pressure levels. Researchers found that, after adjustment for age, gender, and smoking, incident AMI was more common in patients with NAFLD or NASH (HR 1.17, 95% CI 1.05 to 1.30). However, in a subgroup analysis of patients with complete data on traditional risk factors for cardiovascular disease, researchers found no significant difference between patients with NAFLD or NASH and matched controls (HR 1.01, 95% CI 0.91 to 1.12). Similarly, after adjustment for age, gender, and smoking, incident stroke was slightly more common in patients with NAFLD or NASH than in matched controls (HR 1.18, 95% CI 1.11 to 1.24), but in a subgroup analysis of patients with more complete data on risk factors, there was no significant difference (HR 1.04, 95% CI 0.99 to 1.09). In summary, this study suggests that a diagnosis of NAFLD or NASH is not associated with an increased risk of AMI or stroke after adjustment for cardiovascular risk factors, and that the risk of cardiovascular disease and need for preventative treatment should not be assessed differently in these patients.