Risk of cardiovascular events in patients with non-alcoholic fatty liver disease: a systematic review and meta-analysis

European Journal of Preventive Cardiology - Tập 29 Số 6 - Trang 938-946 - 2022
Livnat Alon1, Bernadette Corica1, Valeria Raparelli2,3, Roberto Cangemi1, Stefania Basili1, Marco Proietti4,5,6, Giulio Francesco Romiti1
1Department of Translational and Precision Medicine, Sapienza—University of Rome, Viale del Policlinico 155, Rome 00161, Italy
2Department of Translational Medicine, University of Ferrara, Via Luigi Borsari 46, Ferrara 44121, Italy
3Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9, Canada
4Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, Milan 20122, Italy
5Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Via Camaldoli 64, 20138 Milan, Italy
6Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool 14 3PE, UK

Tóm tắt

Abstract Aims  Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent disease and has been repeatedly associated with an increased risk of cardiovascular disease. However, the extent of such association is unclear. We conducted a systematic review and meta-analysis of the literature to evaluate the risk of myocardial infarction (MI), ischaemic stroke (IS), atrial fibrillation (AF), and heart failure (HF) in NAFLD patients. Methods and results  According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed and EMBASE, from inception to 6 March 2021, and included all studies reporting the incidence of MI, IS, AF, and HF in patients with and without NAFLD. Random-effect fmodels were used to estimate pooled odds ratio (OR), 95% confidence intervals (CI), and 95% prediction intervals (PI); subgroup analyses, meta-regressions, and sensitivity analyses were additionally performed. Among 3254 records retrieved from literature, 20 studies were included. Non-alcoholic fatty liver disease was associated with an increased risk of MI (OR: 1.66, 95% CI: 1.39–1.99, 95% PI: 0.84–3.30), IS (OR: 1.41, 95% CI: 1.29–1.55, 95% PI 1.03–1.93), AF (OR: 1.27, 95% CI: 1.18–1.37, 95% PI: 1.07–1.52), and HF (OR: 1.62, 95% CI: 1.43–1.84, 95% CI: 1.04–2.51). We identified significant subgroup differences according to geographical location, study design, NAFLD definition, and risk of bias; meta-regressions identified mean age, male sex, and study-level characteristics as potential moderators of the risk of MI and IS. Conclusions  Non-alcoholic fatty liver disease was associated with increased risk of MI, IS, AF, and HF. Age, sex, and study characteristics may moderate the strength of this association. Further studies are required to evaluate specific cardiovascular prevention strategies in patients with NAFLD.

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European Journal of Preventive Cardiology

Tập 29 Số 6

938-946

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