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Metabolic-associated fatty liver disease and major adverse cardiac events in patients with chronic coronary syndrome: a matched case–control study

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Abstract

Background and aims

A consensus of experts suggests that nonalcoholic fatty liver disease (NAFLD) does not appropriately reflect current knowledge and metabolic-associated fatty liver disease (MAFLD) is supposed to be a more suitable overarching concept. However, the association of MAFLD with cardiovascular outcomes in patients with coronary artery disease has not been examined yet. Thus, this study aimed to assess the impact of MAFLD on major adverse cardiac events (MACEs) in patients with chronic coronary syndrome (CCS).

Methods

This study included 3306 patients with CCS who were diagnosed with MAFLD. Controls without MAFLD were matched (1:1) to cases by age and gender. All participants were followed up for the occurrence of MACEs. Finally, the association between MAFLD and the risk of MACEs was assessed.

Results

During an average of 55.09 ± 19.92 months follow-up, 376 and 248 MACEs were observed in MAFLD and control groups, respectively. When compared with controls, Kaplan–Meier analysis showed that patients with MAFLD had significantly lower event-free survival rate and multivariate Cox regression analysis further revealed that MAFLD group had significantly increased MACEs risk (both p < 0.05). Stratification analysis suggested that patients with MAFLD overlapped with NAFLD or MAFLD-only had 1.33-fold and 2.32-fold higher risk of MACEs respectively compared with controls (both p < 0.05).

Conclusion

This study firstly showed that MAFLD was significantly associated with the risk of MACEs in patients with CCS. Moreover, this relationship remained unchanged irrespective of whether satisfying the NAFLD criteria, providing novel evidence for the good utility of MAFLD criteria in clinical practice.

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Availability of data and material

The data that support the findings of this study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank all the staff and participants of this study for their important contributions. The data, methods used in the analysis, and materials used to conduct the research will be available to any researcher for purposes of reproducing the results or replicating the procedure from the corresponding author on reasonable request.

Funding

This work was supported by the Capital Health Development Fund (201614035) and CAMS Major Collaborative Innovation Project (2016-I2M-1-011) awarded to JJL, the Fundamental Research Funds for the Central Universities (2019-XHQN09) and the Youth Research Fund of Peking Union Medical College (2019-F11) awarded to HHL. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 BeiLiShi Road, XiCheng District, Beijing, 100037, People’s Republic of China

    Hui-Hui Liu, Ye-Xuan Cao, Jing-Lu Jin, Yuan-Lin Guo, Cheng-Gang Zhu, Na-Qiong Wu, Ying Gao, Rui-Xia Xu, Qian Dong & Jian-Jun Li

  2. Department of Hepatology, MAFLD Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China

    Ming-Hua Zheng

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  1. Hui-Hui Liu
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Contributions

HHL participated in research design and data interpretation, obtained funding, and drafted the manuscript; YXC and JLJ participated in data analysis and work revisions; YLG, CGZ, NQW, YG, RXX, and QD conducted the research, collected data and revised the manuscript. MHZ contributed to the research design and manuscript revisions. JJL designed and supervised this study, obtained funding, and made critical revisions of the manuscript. All authors approve the version to be published and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Jian-Jun Li.

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Conflict of interest

The authors Hui-Hui Liu, Ye-Xuan Cao, Jing-Lu Jin, Yuan-Lin Guo, Cheng-Gang Zhu, Na-Qiong Wu, Ying Gao, Rui-Xia Xu, Qian Dong, Ming-Hua Zheng and Jian-Jun Li declare that they have no conflict of interest.

Ethics approval

All procedures performed in this study involving human participants were approved by the hospital’s ethical review board (FuWai Hospital & National Center for Cardiovascular Diseases, Beijing, China) and complied with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study.

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All authors give final approval of the version to be published, and agree to be accountable for all aspects of the work.

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Cite this article

Liu, HH., Cao, YX., Jin, JL. et al. Metabolic-associated fatty liver disease and major adverse cardiac events in patients with chronic coronary syndrome: a matched case–control study. Hepatol Int 15, 1337–1346 (2021). https://doi.org/10.1007/s12072-021-10252-0

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  • DOI: https://doi.org/10.1007/s12072-021-10252-0

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