Key result
Non-alcoholic fatty liver disease assessed by CT was independently associated with a significantly higher risk of cardiovascular events (HR 5.43) in patients with type 2 diabetes mellitus.
Why the study?
Risk stratification for cardiovascular events in type 2 diabetes mellitus is not established, leading investigators to assess the incremental prognostic value of CT-assessed NAFLD beyond CACS and Framingham risk score.
Does the presence of NAFLD assessed by CT improve the prediction of cardiovascular events beyond CACS and Framingham risk score in T2DM patients with suspected coronary artery disease?
Cohort (n=529)
No
Does the presence of NAFLD assessed by CT improve the prediction of cardiovascular events beyond CACS and Framingham risk score in T2DM patients with suspected coronary artery disease?
Hazard Ratio: 5.43 (95% CI 2.82–10.44)
Absolute Event Rate: 2.95% vs 0.98%
p-value: p=<0.001
NAFLD assessed by non-enhanced CT provides incremental prognostic value beyond CACS and Framingham risk score for predicting cardiovascular events in patients with type 2 diabetes.
Hypothesis-generating for adding CT-assessed NAFLD to CV risk models in T2DM; extends CACS/FRS but needs prospective validation.
Background Risk stratification of cardiovascular events in patients with type 2 diabetes mellitus (T2DM) has not been established. Coronary artery calcium score (CACS) and non-alcoholic fatty liver disease (NAFLD) are independently associated with cardiovascular events in T2DM patients. This study examined the incremental prognostic value of NAFLD assessed by non-enhanced computed tomography (CT) in addition to CACS and Framingham risk score (FRS) for cardiovascular events in T2DM patients. Methods This prospective pilot study included 529 T2DM outpatients with no history of cardiovascular disease who underwent CACS measurement because of suspected coronary artery disease. NAFLD was defined on CT images as a liver:spleen attenuation ratio < 1.0. Cardiovascular events were defined as cardiovascular death, nonfatal myocardial infarction, late coronary revascularization, nonfatal stroke, or hospitalization for heart failure. Results Among 529 patients (61% men, mean age 65 years), NAFLD was identified in 143 (27%). Forty-four cardiovascular events were documented during a median follow-up of 4.4 years. In multivariate Cox regression analysis, NAFLD, CACS, and FRS were associated with cardiovascular events (hazard ratios and 95% confidence intervals 5.43, 2.82–10.44, p < 0.001; 1.56, 1.32–1.86, p < 0.001; 1.23, 1.08–1.39, p = 0.001, respectively). The global χ 2 score for predicting cardiovascular events increased significantly from 27.0 to 49.7 by adding NAFLD to CACS and FRS (p < 0.001). The addition of NAFLD to a model including CACS and FRS significantly increased the C-statistic from 0.71 to 0.80 (p = 0.005). The net reclassification achieved by adding CACS and FRS was 0.551 (p < 0.001). Conclusions NAFLD assessed by CT, in addition to CACS and FRS, could be useful for identifying T2DM patients at higher risk of cardiovascular events.
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Ichikawa et al. (2021) conducted a cohort in Type 2 diabetes mellitus with suspected coronary artery disease (n=529). Non-alcoholic fatty liver disease (NAFLD) assessed by non-enhanced CT vs. No NAFLD was evaluated on Cardiovascular events (cardiovascular death, nonfatal myocardial infarction, late coronary revascularization, nonfatal stroke, or hospitalization for heart failure) (HR 5.43, 95% CI 2.82-10.44, p=<0.001). Non-alcoholic fatty liver disease assessed by CT was independently associated with a significantly higher risk of cardiovascular events (HR 5.43) in patients with type 2 diabetes mellitus.
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