Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Non-alcoholic fatty liver disease is not independent risk factor for cardiovascular disease event: A cohort study
Nima Motamed, Hossein Ajdarkosh, Maral Ahmadi, Dhayaneethie Perumal, G Hossein Ashrafi, Mehdi Nikkhah, Amir Hossein Faraji, Mansooreh Maadi, Mahmoodreza Khoonsari, Nader Rezaie, Behzad Farahani, Fahimeh Safarnezhad Tameshkel, Mitra Ameli, Mahshid Panahi, Mohammad Hadi Karbalaie Niya, Farhad Zamani
Nima Motamed, Department of Social Medicine, Zanjan University of Medical Sciences, Zanjan 1449614535, Iran
Hossein Ajdarkosh, Maral Ahmadi, Mehdi Nikkhah, Amir Hossein Faraji, Mansooreh Maadi, Mahmoodreza Khoonsari, Fahimeh Safarnezhad Tameshkel, Mitra Ameli, Mahshid Panahi, Mohammad Hadi Karbalaie Niya, Farhad Zamani, Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
Dhayaneethie Perumal, Faculty of Science, Engineering and Computing, Kingston University, Kingston, London KT1 2EE, United Kingdom
G Hossein Ashrafi, Cancer Theme SEC Faculty Penrhyn Road, Kingston University, London KT1 2EE, United Kingdom
Nader Rezaie, Department of Pulmonology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran 1449614535, Iran
Behzad Farahani, Department of Cardiology, Iran University of Medical Sciences, Tehran 1449614535, Iran
Author contributions: Motamed N and Zamani F contributed to the conception or design of the work; Ajdarkosh H, Ahmadi M, and Safarnezhad Tameshkel F contributed to the data acquisition; Motamed N, Nikkhah M, Faraji AH contributed to the data analysis; Maadi M, Khoonsari M, Rezaie N, Ameli M contributed to the interpretation of data; Perumal D, Ashrafi GH, Safarnezhad Tameshkel F, and Karbalaie Niya MH contributed to the drafting the work or revising it critically for important intellectual content; Karbalaie Niya MH, Motamed N final approvaled the version to be published.
Institutional review board statement: This project was approved by the ethics committee of Iran University of Medical Sciences, Tehran, Iran by No IR.IUMS.REC.1397.1232.
Informed consent statement: An informed consent was obtained from all patients in both phases and recorded in their health documents before interviews and paraclinical tests.
Conflict-of-interest statement: There is not any potential conflict of interest that might constitute an embarrassment to any of the authors.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Farhad Zamani, MD, Professor, Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran. zamani.f@iums.ac.ir
Received: February 9, 2020
Peer-review started: February 9, 2020
First decision: March 24, 2020
Revised: April 8, 2020
Accepted: May 14, 2020
Article in press: May 14, 2020
Published online: June 27, 2020
ARTICLE HIGHLIGHTS
Research background
Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide. In addition to the relationship with liver related diseases and its complications, this condition may be associated with metabolic co- morbidities such as diabetes mellitus and dyslipidemia. Although previous studies have shown a positive association between cardiovascular disease (CVD) events and NAFLD, results showing an independent association between them are inconsistent.
Research motivation
The main topic in this study is to determine whether non-alcoholic fatty liver can lead to an increase in cardiovascular events independent of other potential risk factors. There is currently no consensus in this regard in the literature. Answering this question will help us determine if people with non-alcoholic fatty liver disease need more stringent cardiovascular interventions than the general population.
Research objectives
This study was conducted to determine if there is an independent association between NAFLD and CVD events.
Research methods
In this large prospective population based cohort study, valid outcome data of 4808 subjects were analyzed. These subjects had been followed up for seven years from phase 1, beginning in 2009-2010 to phase 2 during 2016-2017. The incidence of fatal and non-fatal CVD events were compared between people with and without NAFLD at the seven years follow up. Simple and multiple Cox proportional models were used to determine the association between NAFLD in the primary Phase of the cohort and subsequent fatal and non-fatal CVD events during follow-up.
Research results
The incidence of non-fatal CVD events in males with was significantly higher than in males without NAFLD. A positive association was demonstrated between NAFLD and non-fatal CVD events in males using the simple Cox proportional hazard model, but no independent association was detected between these in the multiple Cox models.
Research conclusions
Based on our results, Non-alcoholic fatty liver does not increase the risk of cardiovascular events independent of other risk factors. Diabetes and age may play a role as potential mediators. The presence of non-alcoholic fatty liver, apart from other cardiovascular risk factors, does not increase the need for stricter interventions to prevent cardiovascular disease than the general population.
Research perspectives
Further studies with a longer follow-up period may be needed in this area.
