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Comparative associations of nonalcoholic fatty liver disease and metabolic dysfunction-associated fatty liver disease with coronary artery calcification: a cross-sectional and longitudinal cohort study

Comparative associations of nonalcoholic fatty liver disease and metabolic dysfunction-associated fatty liver disease with coronary artery calcification: a cross-sectional and longitudinal cohort study
Comparative associations of nonalcoholic fatty liver disease and metabolic dysfunction-associated fatty liver disease with coronary artery calcification: a cross-sectional and longitudinal cohort study
Background: in cross-sectional and retrospective cohort studies, we examined comparative associations between nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction–associated fatty liver disease (MAFLD) and risk of having or developing coronary artery calcification (CAC).

Methods: participants who had health examinations between 2010 and 2019 were analyzed. Liver ultrasonography and coronary artery computed tomography were used to diagnose fatty liver and CAC. Participants were divided into a MAFLD and no-MAFLD group and then NAFLD and no-NAFLD groups. Participants were further divided into no fatty liver disease (reference), NAFLD-only, MAFLD-only, and both NAFLD and MAFLD groups. Logistic regression modeling was performed. Cox proportional hazard model was used to examine the risk of incident CAC in participants without CAC at baseline and who had at least two CAC measurements.

Results: in cross-sectional analyses, 162 180 participants were included. Compared with either the no-NAFLD or no-MAFLD groups, the NAFLD and MAFLD groups were associated with a higher risk of prevalent CAC (NAFLD: adjusted odds ratio [OR], 1.34 [95% CI, 1.29–1.39]; MAFLD: adjusted OR, 1.44 [95% CI, 1.39–1.48]). Among the 4 groups, the MAFLD-only group had the strongest association with risk of prevalent CAC (adjusted OR, 1.60 [95% CI, 1.52–1.69]). Conversely, the NAFLD-only group was associated with a lower risk of prevalent CAC (adjusted OR, 0.76 [95% CI, 0.66–0.87]). In longitudinal analyses, 34 233 participants were included. Compared with either the no-NAFLD or no-MAFLD groups, the NAFLD and MAFLD groups were associated with a higher risk of incident CAC (NAFLD: adjusted hazard ratio, 1.68 [95% CI, 1.43–1.99]; MAFLD: adjusted hazard ratio, 1.82 [95% CI, 1.56–2.13]). Among these 4 groups, the MAFLD-only group had the strongest associations with risk of incident CAC (adjusted hazard ratio, 2.03,[95% CI, 1.62–2.55]). The NAFLD-only group was not independently associated with risk of incident CAC (adjusted hazard ratio, 0.88 [95% CI, 0.44–1.78])

Conclusions: both NAFLD and MAFLD are significantly associated with an increased prevalence and incidence of CAC. These associations tended to be stronger for MAFLD.
cardiovascular disease, coronary artery, lipoprotein, nonalcoholic fatty liver disease, prevalence
1079-5642
482-491
Sung, Ki-Chul
541a0adc-40e7-481f-9517-c7013ab479b7
Yoo, Tae Kyung
242b5816-bd74-41ad-bc8d-1b1ab11093cf
Lee, Mi Yeon
75f2aed3-3b9d-48c3-9c16-16389183862e
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Zheng, Ming-Hua
92d70242-2502-4230-95cb-ab40010c3ad4
Targher, Giovanni
9f4b4a4f-28a8-4729-9aaa-f8d9f2f20f65
Sung, Ki-Chul
541a0adc-40e7-481f-9517-c7013ab479b7
Yoo, Tae Kyung
242b5816-bd74-41ad-bc8d-1b1ab11093cf
Lee, Mi Yeon
75f2aed3-3b9d-48c3-9c16-16389183862e
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Zheng, Ming-Hua
92d70242-2502-4230-95cb-ab40010c3ad4
Targher, Giovanni
9f4b4a4f-28a8-4729-9aaa-f8d9f2f20f65

Sung, Ki-Chul, Yoo, Tae Kyung, Lee, Mi Yeon, Byrne, Christopher, Zheng, Ming-Hua and Targher, Giovanni (2023) Comparative associations of nonalcoholic fatty liver disease and metabolic dysfunction-associated fatty liver disease with coronary artery calcification: a cross-sectional and longitudinal cohort study. Arteriosclerosis, Thrombosis, and Vascular Biology, 43 (3), 482-491. (doi:10.1161/ATVBAHA.122.318661).

Record type: Article

Abstract

Background: in cross-sectional and retrospective cohort studies, we examined comparative associations between nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction–associated fatty liver disease (MAFLD) and risk of having or developing coronary artery calcification (CAC).

Methods: participants who had health examinations between 2010 and 2019 were analyzed. Liver ultrasonography and coronary artery computed tomography were used to diagnose fatty liver and CAC. Participants were divided into a MAFLD and no-MAFLD group and then NAFLD and no-NAFLD groups. Participants were further divided into no fatty liver disease (reference), NAFLD-only, MAFLD-only, and both NAFLD and MAFLD groups. Logistic regression modeling was performed. Cox proportional hazard model was used to examine the risk of incident CAC in participants without CAC at baseline and who had at least two CAC measurements.

Results: in cross-sectional analyses, 162 180 participants were included. Compared with either the no-NAFLD or no-MAFLD groups, the NAFLD and MAFLD groups were associated with a higher risk of prevalent CAC (NAFLD: adjusted odds ratio [OR], 1.34 [95% CI, 1.29–1.39]; MAFLD: adjusted OR, 1.44 [95% CI, 1.39–1.48]). Among the 4 groups, the MAFLD-only group had the strongest association with risk of prevalent CAC (adjusted OR, 1.60 [95% CI, 1.52–1.69]). Conversely, the NAFLD-only group was associated with a lower risk of prevalent CAC (adjusted OR, 0.76 [95% CI, 0.66–0.87]). In longitudinal analyses, 34 233 participants were included. Compared with either the no-NAFLD or no-MAFLD groups, the NAFLD and MAFLD groups were associated with a higher risk of incident CAC (NAFLD: adjusted hazard ratio, 1.68 [95% CI, 1.43–1.99]; MAFLD: adjusted hazard ratio, 1.82 [95% CI, 1.56–2.13]). Among these 4 groups, the MAFLD-only group had the strongest associations with risk of incident CAC (adjusted hazard ratio, 2.03,[95% CI, 1.62–2.55]). The NAFLD-only group was not independently associated with risk of incident CAC (adjusted hazard ratio, 0.88 [95% CI, 0.44–1.78])

Conclusions: both NAFLD and MAFLD are significantly associated with an increased prevalence and incidence of CAC. These associations tended to be stronger for MAFLD.

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Accepted/In Press date: 18 January 2023
e-pub ahead of print date: 2 February 2023
Published date: 1 March 2023
Additional Information: Funding Information: G. Targher is supported in part by grants from the University School of Medicine of Verona, Verona, Italy. C.D. Byrne was supported in part by the Southampton National Institute for Health Research Biomedical Research Centre (NIHR203319), United Kingdom. Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved.
Keywords: cardiovascular disease, coronary artery, lipoprotein, nonalcoholic fatty liver disease, prevalence

Identifiers

Local EPrints ID: 474509
URI: http://eprints.soton.ac.uk/id/eprint/474509
ISSN: 1079-5642
PURE UUID: 7e72b045-ebee-4d2c-9c6c-c6e85b34a02e
ORCID for Christopher Byrne: ORCID iD orcid.org/0000-0001-6322-7753

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Date deposited: 23 Feb 2023 17:44
Last modified: 05 Aug 2023 04:01

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Contributors

Author: Ki-Chul Sung
Author: Tae Kyung Yoo
Author: Mi Yeon Lee
Author: Ming-Hua Zheng
Author: Giovanni Targher

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