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Does the risk of cardiovascular events differ between biopsy-proven NAFLD and MAFLD?

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Abstract

Background/purpose

Cardiovascular disease (CVD) is the leading cause of death among individuals with non-alcoholic fatty liver disease (NAFLD). Recently, NAFLD was renamed metabolic-associated fatty liver disease (MAFLD). This study aimed to compare cardiovascular risk (CVR) and CVD between patients with NAFLD and MAFLD.

Methods

Retrospective cross-sectional study of biopsy-proven liver steatosis performed between 2013 and 2018 at a university hospital. Cases were divided into NAFLD or MAFLD and demographic, clinical, and laboratory data were collected to assess CVR (through the atherosclerotic cardiovascular disease risk estimator and atherogenic indices) and CVD.

Results

Out of 1233 liver biopsies, 171 (13.9%) presented steatosis. Of these, 109 patients met diagnostic criteria for NAFLD (63.7%) and 154 (90.1%), for MAFLD. In the NAFLD group, 78% of the cases had steatohepatitis, 24.8% had cirrhosis, and 3.7%, hepatocellular carcinoma (HCC). In the MAFLD group, 72.7% of the cases had liver inflammatory activity, 28.6% had cirrhosis, and 13.6% had HCC. In patients with MAFLD and NAFLD, CVR was intermediate/high (36.4 and 25.7%, p = 0.209) and CVD occurred in 20.1 and 12.8% (p = 0.137) of the cases, respectively, with no influence of liver injury severity. We observed a significant increase in high 10-year CVR (p = 0.020) and CVD (p = 0.007) in patients with MAFLD and concomitant viral infection (HCV and/or HBV) compared to cases with MAFLD only.

Conclusion

Patients with both NAFLD and MAFLD had intermediate/high CVR, with a high rate of CVD. Patients with MAFLD and concomitant viral infection showed significantly increased CVR and CVD compared to those without viral infection.

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Data availability

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Abbreviations

AC:

Atherogenic coefficient

ALT:

Alanine aminotransferase

ASCVD:

Atherosclerotic cardiovascular disease

AST:

Aspartate aminotransferase

BMI:

Body mass index

CVD:

Cardiovascular disease

CRI:

Castelli’s Risk Index

CRP:

C-reactive protein

CVR:

Cardiovascular risk

GGT:

Gamma-glutamyl transferase

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HDL:

High-density lipoprotein

INR:

International normalized ratio

LDL:

Low-density lipoprotein

MAFLD:

Metabolic-associated fatty liver disease

NAFLD:

Non-alcoholic fatty liver disease

NAS:

NAFLD activity score

NASH:

Non-alcoholic steatohepatitis

TC:

Total cholesterol

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Acknowledgements

We would like to thank the Research Incentive Fund—Hospital de Clínicas de Porto Alegre (FIPE—HCPA), CNPq (National Council for Technological and Scientific Development), and CAPES (Coordination for the Improvement of Higher Education Personnel) for the financial support.

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Nothing to disclose.

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Author notes

  1. Gabriel Tayguara Silveira Guerreiro and Larisse Longo contributed equally to the writing of this article.

Authors and Affiliations

  1. Graduate Program in Gastroenterology and Hepatology, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil

    Gabriel Tayguara Silveira Guerreiro, Larisse Longo, Mariana Alves Fonseca & Mário Reis Álvares-da-Silva

  2. Experimental Laboratory of Hepatology and Gastroenterology, Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

    Gabriel Tayguara Silveira Guerreiro, Larisse Longo, Valessa Emanoele Gabriel de Souza & Mário Reis Álvares-da-Silva

  3. Division of Gastroenterology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

    Mário Reis Álvares-da-Silva

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Contributions

GTSG: methodology, formal analysis, investigation, data curation writing—original draft and writing—review and editing visualization; LL: conceptualization, methodology, formal analysis, investigation, data curation writing—original draft and writing—review and editing visualization; MAF: conceptualization, methodology and review and editing visualization; VEGDS: formal analysis, investigation; MRÁ: conceptualization, methodology, data curation writing—original draft and writing—review and editing visualization, visualization, supervision and project administration.

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Correspondence to Larisse Longo.

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Gabriel Tayguara Silveira Guerreiro, Larisse Longo, Mariana Alves Fonseca, Valessa Emanoele Gabriel de Souza and Mário Reis Álvares-da-Silva declare that they have no conflict of interest.

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This study was approved by the Ethics Committee of Hospital de Clínicas de Porto Alegre, CAAE 79523617.1.0000.5327, and follows the guidelines for studies in humans. As this is a Retrospective cross-sectional study, it is not necessary to apply the consent form.

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Guerreiro, G.T.S., Longo, L., Fonseca, M.A. et al. Does the risk of cardiovascular events differ between biopsy-proven NAFLD and MAFLD?. Hepatol Int 15, 380–391 (2021). https://doi.org/10.1007/s12072-021-10157-y

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