Amsterdam, The Netherlands, Friday 26 April 2013: A study presented today at the International Liver CongressTM 2013 – which evaluated the relationship between non-alcoholic fatty liver disease (NAFLD), early predictors of atherosclerosis and the 10-year Framingham risk score (FRS) – showed that NAFLD increases the risk of early atherosclerotic lesions independent of established cardiovascular (CV) risk factors.
NAFLD is one of the most common causes of chronic liver disease. Patients with NAFLD have an excess prevalence of CV events and typically have an increase frequency of risk factors already known to be directly related to atherosclerosis. As a consequence, it remains unclear if the presence of fatty liver should be regarded as an independent risk factor for CV disease.
Over 5000 patients with two or more traditional CV risk factors (without previous CV events), low alcohol intake (
<50g/day) and without known liver diseases (viral hepatitis, hemochromatosis, Wilson disease or drug induced liver injury) underwent carotid ultrasonography with measurement of carotid intima-media thickness (C-IMT). Carotid plaques (CP) were defined as C-IMT>
1,5 mm at carotid bifurcation. The Fatty Liver Index (FLI), a surrogate marker of hepatic steatosis when >60, and the Framingham score (FRS) were calculated.
Patients with a FLI of 60 or more also had a higher BMI and increased levels of liver enzymes (ALT, AST, GGT) (p<0.0001). They also had higher C-IMT and higher FRS (0.64+0.16 vs. 0.61+0.13, p< 0,0001 and 14.7+8.8 vs. 8.3+6.6, p< 0.0001 respectively). In multivariate analysis FLI was independently associated with C-IMT (p< 0.0001) and CP (beta =0.179, p=0.01), independent of age, cholesterol level, presence of diabetes or high blood pressure.
This study demonstrated that NAFLD is highly prevalent in patients at high risk of CV diseases and is an independent predictor of early atherosclerosis and 10-years CV risk beyond classical CV risk factors. These findings strengthen the evidence that NAFLD is a heterogeneous entity requiring a multidisciplinary approach and modified screening strategies.
Type-2 diabetes and dyslipidemia are known risk factors usually associated with cardiovascular and liver-related deaths in NAFLD. A second study presented today evaluated the 10-year prognostic value of non-invasive markers FibroTest and SteatoTest for overall survival (OS), survival without liver-related death (LRD) and cardiovascular-related death (CVD) in patients with diabetes and/or dyslipidemia without known liver disease.
Non-alcoholic fatty liver
Non-alcoholic fatty liver disease (NAFLD) is the term for a wide range of conditions caused by a build-up of fat within the liver cells. It is usually seen in people who are overweight or obese.
A healthy liver should contain little or no fat. Most people with NAFLD only carry small amounts of fat, which doesn’t usually cause any symptoms and isn’t harmful to the liver. This early form of the disease is known as simple fatty liver, or steatosis.
Simple fatty liver is very common in the UK, reflecting the number of people who are obese or overweight. It is one of the most common forms of liver disease, with an estimated one in five people in the UK having early forms of NAFLD.
However, just because simple fatty liver is harmless, it doesn’t mean it is not a serious condition:
in some people, if the fat builds up and gets worse, it can eventually lead to scarring of the liver
as the disease is linked to being overweight or obese, people with any stage of the disease are more at risk of developing a stroke or heart attack
NAFLD is often diagnosed after liver function tests (a type of blood test) produce an abnormal result and other liver conditions, such as hepatitis, are ruled out.
Over 2000 patients were prospectively followed for 12 years and mortality data collected. The study found in diabetics, regardless of associated hyperlipidaemia, FibroTest had a significant 10-year prognostic value for the overall and without liver-related death survivals. SteatoTest was also predictive of CV-related death in hyperlipidemia patients.
Both OS and survival without CVD were significantly higher in the hyperlipidemia group than in the diabetic or diabetic with hyperlipidemia group. The hyperlipidemia group with advanced steatosis (AS) tested by Steatotest had lower survival without-CVD, compared to non-AS: 97(94-99) vs. 99(98-99, P=0.004). FibroTest remained significant for the prediction of OS in the diabetic group [risk ratio (RR) = 136.9 (95%CI 11.6-1610; P< 0.0001)] and in the diabetic with hyperlipidemia group [RR=7.1 (95%CI 2.1-24; P< 0.0001)].
Framingham Risk Score
About the Framingham Risk Score
In the US, most doctors assess a person’s risk of heart disease using a risk calculator based on the findings from a large, long-term study conducted in Framingham, Massachusetts. This is referred to as your Framingham risk or your Framingham risk score. The Framingham risk score uses a system that includes age, sex, total and HDL (good) cholesterol, smoking, and blood pressure.
What does the Framingham risk score mean?
Your Framingham risk score is your risk of having a heart attack or dying from heart disease within 10 years.
Low risk = less than 10% chance
Intermediate risk = 10% to 20% chance
High risk = more than 20% chance
The study concluded that patients with type-2 diabetes, especially those with associated hyperlipidemia, presented particularly higher rates of advanced fibrosis and steatosis as well as higher overall and liver-related mortalities than those with isolated hyperlipidemia.
EASL’s Education Councillor, Jean-Francois Dufour commented. “These studies reinforce the view that in patients with other risk factors such as diabetes or other metabolic impairment, the degree of liver fat deposition is an important determinant of long term mortality, not only due to liver disease progression, but other causes, particularly cardiovascular events. Although patients with NAFLD have long been known to suffer from excess cardiovascular disease, it was uncertain if this was mediated through a higher risk of earlier atherosclerotic lesions. These studies show that NAFLD is an independent predictor of cardiovascular risk.”
Disclaimer: the data referenced in this release is based on the submitted abstract. More recent data may be presented at the International Liver Congress™ 2013.
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Notes to Editors
About EASL
EASL is the leading European scientific society involved in promoting research and education in hepatology. EASL attracts the foremost hepatology experts and has an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.
EASL’s main focus on education and research is delivered through numerous events and initiatives, including:
The International Liver CongressTM which is the main scientific and professional event in hepatology worldwide
Meetings including Monothematic and Special conferences, Post Graduate courses and other endorsed meetings that take place throughout the year
Clinical and Basic Schools of Hepatology, a series of events covering different aspects in the field of hepatology
Journal of Hepatology published monthly
Participation in a number of policy initiatives at European level
About The International Liver Congress™ 2013
The International Liver Congress™ 2013, the 48th annual meeting of the European Association for the study of the Liver, is being held at the RAI Convention Centre in Amsterdam from April 24 – 28, 2013. The congress annually attracts in excess of 9000 clinicians and scientists from around the world and provides an opportunity to hear the latest research, perspectives and treatments of liver disease from principal experts in the field.
References:
1 Pais R et al, NAFLD IS SIGNIFICANTLY INCREASED IN PATIENTS AT HIGH RISK FOR CARDIOVASCULAR EVENTS AND IS CORRELATED WITH EARLY PREDICTORS OF ATHEROSCLEROSIS AND THE FRAMINGHAM SCORE. Presented at the International Liver Congress™ 2013
2 Perazzo H et al, 10-YEARS PROGNOSTIC VALUE OF FIBROTEST AND STEATOTEST FOR LIVER-RELATED AND CARDIOVASCULAR DEATH IN PATIENTS WITH TYPE-2 DIABETES AND/OR HYPERLIPIDEMIA. Presented at the International Liver Congress™ 2013
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