Risk of cardiovascular, cardiac and arrhythmic complications in patients with non-alcoholic fatty liver disease

Table 1 Main cross-sectional study examining the association of non-alcoholic fatty liver disease with the presence and severity of clinical coronary heart disease, ordered by year

Ref.	Study characteristics	NAFLD diagnosis	CHD diagnosis	Main findings
Lin et al[31], 2005	2088 male workers undergoing an annual health examination screening; NAFLD in 29.5%	US	Patient history, ECG	NAFLD associated with higher prevalence of CHD, independently of obesity and other traditional CVD risk factors. The odds for CHD increased progressively with ultrasonographic severity of NAFLD
Targher et al[32], 2007	2839 type 2 diabetic outpatients; NAFLD in 69.5%	US	Patient history, review of patient records, ECG, doppler ultrasound of carotid and lower limb arteries	NAFLD associated with higher prevalence of coronary, cerebrovascular and peripheral vascular disease than their counterparts without NAFLD, independently of traditional CVD risk factors, hemoglobin A1c, medication use and MetS features
Arslan et al[33], 2007	92 consecutive Turkish patients admitted with ACS; NAFLD in 70%	US	CAG (elective)	NAFLD was an independent predictor of CHD (> 50% stenosis of ≥ 1 major coronary artery) after adjustment for traditional CVD risk factors and MetS features
Mirbagheri et al[34], 2007	317 Iranian patients admitted for either ACS, angina or suspected CHD; NAFLD in 54%	US	CAG (elective)	NAFLD was an independent predictor of "clinically relevant" CHD (> 30% stenosis of ≥ 1 major coronary artery) after adjustment for CVD risk factors and MetS features
Alper et al[35], 2008	80 Turkish patients with MS (stable or unstable angina, prognostic reasons); NAFLD in 54%	US	CAG (acute and elective)	NAFLD was the only independent predictor of severe CHD (> 70% stenosis of ≥ 1 major coronary artery) after adjustment for established CVD risk factors and MetS features
Akabame et al[36], 2008	298 consecutive Japanese patients with suspected CHD; NAFLD in 20%	CT	CT (elective)	NAFLD was independently associated with remodeling lesions or lipid core of coronary plaques but not with calcified coronary plaques or stenosis
Açikel et al[37], 2009	355 consecutive Turkish patients admitted for ACS or CHD suspicion; NAFLD in 60%	US	CAG (acute and elective)	NAFLD was an independent predictor of CHD (> 50% stenosis of ≥ 1 major coronary artery) after adjustment for conventional CVD risk factors
Assy et al[38], 2010	29 Israeli patients with low or intermediate risk of CHD and NAFLD and 32 healthy controls matched for age and sex	CT	CT (elective)	NAFLD was associated with greater prevalence of calcified and non-calcified coronary plaques, independently of the MetS and plasma C-reactive protein
Targher et al[39], 2010	250 type 1 diabetic patients; NAFLD in 44.4%	US	Patient history, chart review, ECG, doppler ultrasound of carotid and lower limb arteries	NAFLD was associated with higher prevalence of coronary, cerebrovascular and peripheral vascular disease than their counterparts without NAFLD, independently of traditional CVD risk factors, medication use, hemoglobin A1c, and albuminuria
Sun et al[40], 2011	542 hospitalized Chinese patients with high suspicion of CHD; NAFLD in 46%	CT	CAG (elective)	NAFLD was associated with greater severity of CHD, independently of traditional CVD risk factors
Wong et al[41] 2011	612 Chinese patients with suspicion of CHD; NAFLD in 58%	US	CAG (elective)	NAFLD was associated with CHD, independently of established CVD risk factors and MetS features
Domanski et al[42], 2012	377 patients with NAFLD (retrospective chart review); 219 of these patients had NASH	Biopsy	History of CVD (stroke, unstable angina, myocardial infarction, congestive heart failure, or need for coronary revascularization)	No increased prevalence of CVD in NASH patients compared with those with non-NASH fatty liver
Agaç et al[43], 2013	80 Turkish patients with ACS; NAFLD in 81%	US	CAG (acute)	NAFLD was independently associated with a greater severity of CHD (by Syntax score)
Boddi et al[44], 2013	95 consecutive non-diabetic Italian patients admitted for ACS; NAFLD in 87%	US	CAG (acute)	Presence and severity of NAFLD was independently associated with a three-fold higher risk of multi-vessel CHD
Inci et al[45], 2013	136 consecutive Turkish patients with CHD (stable angina or positive stress test results)	US	CAG (elective)	NAFLD was associated with greater severity of CHD, independently of traditional CVD risk factors

ACS: Acute coronary syndrome; NAFLD: Non-alcoholic fatty liver disease; CAG: Coronary angiography; CT: Computed tomography; CVD: Cardiovascular disease; ECG: Electrocardiogram; MetS: Metabolic syndrome; NASH: Non-alcoholic steatohepatitis; US: Ultrasonography.