Association of Non-Alcoholic Fatty Liver Disease with Cardiovascular Disease and All-Cause Death in Patients with Type 2 Diabetes Mellitus NAFLD and Cardiovascular Risk in T2DM
Article Sidebar
Main Article Content
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is increasingly prevalent among patients with type 2 diabetes mellitus (T2DM) and is a significant independent risk factor for cardiovascular disease (CVD) and all-cause mortality.
Objective: To investigate the association between NAFLD and the incidence of CVD and all-cause mortality in patients with T2DM.
Methods: This retrospective cohort study included 300 T2DM patients, divided into NAFLD (n=150) and non-NAFLD (n=150) groups. Baseline data on age, BMI, HbA1c, gender, hypertension, dyslipidemia, smoking status, duration of diabetes, and medication use were collected. Survival analysis was conducted using Kaplan-Meier curves, and statistical significance was determined through t-tests, chi-square tests, and multivariate Cox regression using SPSS version 25.
Results: Patients with NAFLD had significantly higher BMI (30.2 ± 4.5 vs. 27.8 ± 3.9 kg/m², p=0.01), HbA1c (8.5 ± 1.2 vs. 7.8 ± 1.1%, p=0.02), and increased risk of CVD events (HR 1.8, p=0.004) and all-cause mortality (HR 2.1, p=0.002).
Conclusion: NAFLD is associated with higher rates of CVD and all-cause mortality in T2DM patients, highlighting the need for targeted management strategies.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, Sanyal AJ. The Diagnosis and Management of Non-Alcoholic Fatty Liver Disease: Practice Guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-357.
Anstee QM, Targher G, Day CP. Progression of NAFLD to Diabetes Mellitus, Cardiovascular Disease or Cirrhosis. Nat Rev Gastroenterol Hepatol. 2013;10(6):330-344.
Targher G, Day CP, Bonora E. Risk of Cardiovascular Disease in Patients with Nonalcoholic Fatty Liver Disease. N Engl J Med. 2010;363(14):1341-1350.
Kim D, Kim WR, Kim HJ, Therneau TM. Association Between Noninvasive Fibrosis Markers and Mortality Among Adults with Nonalcoholic Fatty Liver Disease in the United States. Hepatology. 2013;57(4):1357-1365. doi:10.1002/hep.26156.
Tilg H, Moschen AR. Evolution of Inflammation in Nonalcoholic Fatty Liver Disease: The Multiple Parallel Hits Hypothesis. Hepatology. 2010;52(5):1836-1846.
Feijóo-Bandín S, Aragón-Herrera A, Moraña-Fernández S, Anido-Varela L, Tarazón E, Roselló-Lletí E, Portolés M, Moscoso I, Gualillo O, González-Juanatey JR, Lago F. Adipokines and Inflammation: Focus on Cardiovascular Diseases. Int J Mol Sci. 2020;21(20):7711. doi:10.3390/ijms21207711.
Konyn P, Ahmed A, Kim D. Causes and Risk Profiles of Mortality Among Individuals with Nonalcoholic Fatty Liver Disease. Clin Mol Hepatol. 2023;29(Suppl). doi:10.3350/cmh.2022.0351.
Ballestri S, Zona S, Targher G, Romagnoli D, Baldelli E, Nascimbeni F, Roverato A, Guaraldi G, Lonardo A. Nonalcoholic Fatty Liver Disease Is Associated with an Almost Twofold Increased Risk of Incident T2DM and Metabolic Syndrome: Evidence from a Systematic Review and Meta-Analysis. J Gastroenterol Hepatol. 2016;31(5):936-944. doi:10.1111/jgh.13264.
Cao L, An Y, Liu H, Jiang J, Liu W, Zhou Y, Shi M, Dai W, Lv Y, Zhao Y, Lu Y. Global Epidemiology of T2DM in Patients with NAFLD or MAFLD: A Systematic Review and Meta-Analysis. BMC Med. 2024;22(1):101.
Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global Epidemiology of Nonalcoholic Fatty Liver Disease: Meta-Analytic Assessment of Prevalence, Incidence, and Outcomes. Hepatology. 2016;64(1):73-84. doi:10.1002/hep.28431.
Bonora E, Targher G. Increased risk of cardiovascular disease and chronic kidney disease in NAFLD. Nature reviews Gastroenterology & hepatology. 2012;9(7):372-81.
Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nature reviews Gastroenterology & hepatology. 2013;10(6):330-44.
Lonardo A, Ballestri S, Guaraldi G, Nascimbeni F, Romagnoli D, Zona S, et al. Fatty liver is associated with an increased risk of diabetes and cardiovascular disease-Evidence from three different disease models: NAFLD, HCV and HIV. World journal of gastroenterology. 2016;22(44):9674.
Targher G, Byrne CD, Tilg H. NAFLD and increased risk of cardiovascular disease: clinical associations, pathophysiological mechanisms and pharmacological implications. Gut. 2020;69(9):1691-705.
Caussy C, Aubin A, Loomba R. The relationship between type 2 diabetes, NAFLD, and cardiovascular risk. Current diabetes reports. 2021;21:1-13.
Galiero R, Caturano A, Vetrano E, Cesaro A, Rinaldi L, Salvatore T, et al. Pathophysiological mechanisms and clinical evidence of relationship between Nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease. Reviews in cardiovascular medicine. 2021;22(3):755-68.
Kasper P, Martin A, Lang S, Kuetting F, Goeser T, Demir M, et al. NAFLD and cardiovascular diseases: a clinical review. Clinical research in cardiology. 2021;110:921-37.
Targher G, Corey KE, Byrne CD. NAFLD, and cardiovascular and cardiac diseases: Factors influencing risk, prediction and treatment. Diabetes & metabolism. 2021;47(2):101215.
Byrne CD, Targher G. Non‐alcoholic fatty liver disease‐related risk of cardiovascular disease and other cardiac complications. Diabetes, Obesity and Metabolism. 2022;24:28-43.
Zhang Z, Zhang L, Jiang W, Du T, Yuan G. Non-obese NAFLD had no better cardio-metabolic risk profile than obese NAFLD in type 2 diabetic patients. Cardiovascular Diabetology. 2022;21(1):210.
Li M, Wang H, Zhang X-j, Cai J, Li H. NAFLD: An emerging causal factor for cardiovascular disease. Physiology. 2023;38(6):255-65.