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Nonalcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis

Nonalcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis
Nonalcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis
BACKGROUND & AIMS: There have been many studies of the effects of nonalcoholic fatty liver disease (NAFLD) and the risk of cardiovascular disease (CVD), but these have produced conflicting results. We performed a meta-analysis of these studies to quantify the magnitude of the association between NAFLD (and NAFLD severity) and risk of CVD events.

METHODS: We searched PubMed, Google scholar, and Web of Science databases using terms "NAFLD", "cardiovascular events", "cardiovascular mortality", "prognosis" and their combinations to identify observational studies published through January 2016. We included only observational studies conducted in adults >18 years and in which NAFLD was diagnosed on imaging or histology. Data from selected studies were extracted and meta-analysis was then performed using random effects modelling.

RESULTS: A total of 16 unique, observational prospective and retrospective studies with 34,043 adult individuals (36.3% with NAFLD) and approximately 2,600 CVD outcomes (>70% CVD deaths) over a median period of 6.9 years were included in the final analysis. Patients with NAFLD had a higher risk of fatal and/or non-fatal CVD events than those without NAFLD (random effect odds ratio [OR] 1.64, 95% CI 1.26-2.13). Patients with more 'severe' NAFLD were also more likely to develop fatal and non-fatal CVD events (OR 2.58; 1.78-3.75). Sensitivity analyses did not alter these findings. Funnel plot and Egger's test did not reveal significant publication bias.

CONCLUSIONS: NAFLD is associated with an increased risk of fatal and non-fatal CVD events. However, the observational design of the studies included does not allow to draw definitive causal inferences.

LAY SUMMARY: The data on whether NAFLD by itself is associated with increased cardiovascular events and death remains an issue of debate. The findings of this updated and large meta-analysis of observational studies indicate that NAFLD is significantly associated with an increased risk of fatal and non-fatal cardiovascular events. However, the observational design of the studies included does not allow us to prove that NAFLD causes cardiovascular disease. Clinicians who manage patients with NAFLD should not focus only on liver disease but should also consider the increased risk of cardiovascular disease and undertake early, aggressive risk factor modification.
0168-8278
589-600
Targher, G.
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Byrne, C.D.
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Lonardo, A.
c7080bf1-7038-4186-ae7d-cc7685580262
Zoppini, G.
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Barbui, C.
dccf16d5-76c8-438a-9043-549e52dbde87
Targher, G.
5a842bd2-91c4-4063-b639-da6c681f3698
Byrne, C.D.
1370b997-cead-4229-83a7-53301ed2a43c
Lonardo, A.
c7080bf1-7038-4186-ae7d-cc7685580262
Zoppini, G.
21719d3f-197a-43ba-a955-366ea9ac0764
Barbui, C.
dccf16d5-76c8-438a-9043-549e52dbde87

Targher, G., Byrne, C.D., Lonardo, A., Zoppini, G. and Barbui, C. (2016) Nonalcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis. Journal of Hepatology, 65 (3), 589-600. (doi:10.1016/j.jhep.2016.05.013). (PMID:27212244)

Record type: Article

Abstract

BACKGROUND & AIMS: There have been many studies of the effects of nonalcoholic fatty liver disease (NAFLD) and the risk of cardiovascular disease (CVD), but these have produced conflicting results. We performed a meta-analysis of these studies to quantify the magnitude of the association between NAFLD (and NAFLD severity) and risk of CVD events.

METHODS: We searched PubMed, Google scholar, and Web of Science databases using terms "NAFLD", "cardiovascular events", "cardiovascular mortality", "prognosis" and their combinations to identify observational studies published through January 2016. We included only observational studies conducted in adults >18 years and in which NAFLD was diagnosed on imaging or histology. Data from selected studies were extracted and meta-analysis was then performed using random effects modelling.

RESULTS: A total of 16 unique, observational prospective and retrospective studies with 34,043 adult individuals (36.3% with NAFLD) and approximately 2,600 CVD outcomes (>70% CVD deaths) over a median period of 6.9 years were included in the final analysis. Patients with NAFLD had a higher risk of fatal and/or non-fatal CVD events than those without NAFLD (random effect odds ratio [OR] 1.64, 95% CI 1.26-2.13). Patients with more 'severe' NAFLD were also more likely to develop fatal and non-fatal CVD events (OR 2.58; 1.78-3.75). Sensitivity analyses did not alter these findings. Funnel plot and Egger's test did not reveal significant publication bias.

CONCLUSIONS: NAFLD is associated with an increased risk of fatal and non-fatal CVD events. However, the observational design of the studies included does not allow to draw definitive causal inferences.

LAY SUMMARY: The data on whether NAFLD by itself is associated with increased cardiovascular events and death remains an issue of debate. The findings of this updated and large meta-analysis of observational studies indicate that NAFLD is significantly associated with an increased risk of fatal and non-fatal cardiovascular events. However, the observational design of the studies included does not allow us to prove that NAFLD causes cardiovascular disease. Clinicians who manage patients with NAFLD should not focus only on liver disease but should also consider the increased risk of cardiovascular disease and undertake early, aggressive risk factor modification.

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More information

Accepted/In Press date: 9 May 2016
e-pub ahead of print date: 17 May 2016
Published date: September 2016
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 396811
URI: http://eprints.soton.ac.uk/id/eprint/396811
ISSN: 0168-8278
PURE UUID: 37abaaec-0cbb-47a9-965a-a595ffd28f7f
ORCID for C.D. Byrne: ORCID iD orcid.org/0000-0001-6322-7753

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Date deposited: 14 Jun 2016 13:25
Last modified: 07 Oct 2020 05:11

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