Association between nonalcoholic fatty liver disease and the incidence of cardiovascular and renal events

ABSTRACT

Recent data suggest that the presence of non-alcoholic fatty liver disease [NAFLD] may be linked to increased cardiovascular and chronic kidney diseases. Here we assess whether NAFLD, as diagnosed by ultrasound, predicts the risk of incident cardiovascular and renal impairment events. A total of 1150 patients with normal or near normal liver and kidney functions, and without protienuria or histories of cardiovascular accident were included in this multicenter prospective observational cohort study. All patients were subjected to full clinical evaluation, laboratory investigation including estimation of the GFR and immunonephelometric evaluation for protienuria, and abdominal ultrasonography for diagnosis of NAFLD. The metabolic syndrome was defined according to the modified National Cholesterol Education Program [NCEP]-ATP criteria. All patients followed up periodically over three years for the incidence of cardiovascular [including coronary heart disease, ischemic stroke and cerebral hemorrhage] and renal impairment events. Only 747 [62.25%] patients completed the follow-up examination and were included in the final analysis. 35.8% of them fulfilled the sonographic criteria of NAFLD. The frequency of cardiovascular accident and renal impairment was significantly higher in them 136 patients [50.7%] vs. 110 [23%]; P < 0.001 for cardiovascular events, 88 [32.8%] vs. 88 [18.4%], P < 0.001 for microalbuminuria; and 24 [8.9%] vs. 14 [2.9%], P < 0.001 for macroalbuminuria. Also, mean estimated glomerular filtration rate [eGFR] was significantly lower in patients with NAFLD [96 +/- 23.28 vs. 111 +/- 28.37; P < 0.001]. Logistic regression analysis revealed that NAFLD was the best predictor for cardiovascular and renal impairment.