Individuals with T2D and NAFLD have elevated CVD, mortality risk
Individuals with type 2 diabetes (T2D) who were hospitalized with nonalcoholic fatty liver disease (NAFLD) had an elevated risk of cardiovascular disease (CVD), and death due to CVD, hepatocellular cancer, and other causes, according to a study presented at EASD 2017.
This population-based, retrospective cohort study from Scotland included 133,312 individuals aged 40–89 years diagnosed with T2D between 2004 and 2013. Of these, 1.5 percent (n=1,998) had a history of hospitalization with NAFLD (mean age at diabetes diagnosis 60 years, 50.8 percent male), 64 percent (n=1,283) with a record of fatty liver or nonalcoholic steatohepatitis alone, and the remaining 36 percent (n=715) with a record of one or more of the following: fibrosis, sclerosis, cirrhosis, or portal hypertension. About 20 percent of patients (with or without NAFLD) had a history of CVD prior to diabetes diagnosis.
After a median 4.7-year follow-up period, compared with patients with T2D and no evidence of liver disease, patients with T2D and NAFLD had elevated risks of incident or recurrent CVD (hazard ratio [HR], 1.62, 95 percent confidence interval [CI], 1.47–1.77), all-cause mortality (HR, 2.11, 95 percent CI, 1.92–2.32), CVD mortality (HR, 1.39, 95 percent CI, 1.10–1.74), and other causes of death (HR, 3.16, 95 percent CI, 2.77–3.59). [EASD 2017, abstract OP 02(7)]
The risk of cancer mortality was also elevated among patients with both T2D and NAFLD compared with patients with T2D and no liver disease (HR, 1.15, 95 percent CI, 0.92–1.42), particularly with regards to hepatocellular carcinoma-related mortality (HR, 41.9, 95 percent CI, 27.1–64.8).
“More severe forms of NAFLD [as presumably identified in this study] are independently associated with increased incidence and recurrence of CVD and increased mortality from several causes,” said Professor Sarah Wild from the Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland, who presented the findings.
“Our results provide further evidence that it is important to intervene early to prevent NAFLD progression. Since the early stages of NAFLD respond to lifestyle changes [similar to those that are recommended for people with diabetes], these should be implemented when a diagnosis of NAFLD is established,” she said.
“There are no licensed drugs for treating NAFLD at the moment, so being aware that lifestyle changes are very challenging, there’s still a major requirement to develop treatments for NAFLD,” she said.
The use of data of only patients hospitalized with NAFLD and not of outpatients or those diagnosed with NAFLD in primary care may have led to underestimation of the prevalence of NAFLD, said Wild. The absolute event rates are thus, also more likely reflective of severe liver disease, as those with milder cases may have been included in the comparison group, she said.