Prospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2020; 12(6): 323-331
Published online Jun 27, 2020. doi: 10.4254/wjh.v12.i6.323
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
Processing time: 139 Days and 21 Hours
Abstract
BACKGROUND

There are no consistent results between previous studies for an independent association between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) events.

AIM

To determine if there is an independent association between NAFLD and CVD events.

METHODS

In the present study, valid outcome data of 4808 subjects were available for phase 2 of our cohort study. These subjects had been followed up for seven years from phase 1, beginning in 2009-2010 to phase 2 during 2016-2017. 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.

RESULTS

The incidence of non-fatal CVD events in males with NAFLD was significantly higher (P = 0.004) than in males without NAFLD. A positive association was demonstrated between NAFLD and non-fatal CVD events in males (Hazard ratio = 1.606; 95%CI: 1.166-2.212; P = 0.004) by the simple Cox proportional hazard model, but no independent association was detected between these in the multiple Cox models.

CONCLUSION

No independent association was detected between NAFLD and CVD. It is likely that diabetes mellitus and age may be the principle mediators in this regard.

Keywords: Non-alcoholic fatty liver disease; Cardiovascular disease; Cohort; Type 2 diabetes mellitus; Risk factor; Follow up

Core tip: We evaluated the association between non-alcoholic fatty liver disease and the incidence of cardiovascular disease events after seven years follow up, in a large prospective cohort study. Based on our results, no independent association was observed between non-alcoholic fatty liver disease and cardiovascular disease events. Diabetes and age may play a role as potential mediators.