Transient elastography through controlled attenuated parameter assisting the stratification of cardiovascular disease risk in NAFLD patients - 03/12/20

Doi : 10.1016/j.clinre.2020.11.010

Rui de Sousa Magalhães ^a,^b,^c,⁎ , Sofia Xavier ^a,^b,^c, Joana Magalhães ^a,^b,^c, Bruno Rosa ^a,^b,^c, Carla Marinho ^a,^b,^c, José Cotter ^a,^b,^c
^a Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Portugal
^b Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
^c ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal

^⁎Corresponding author at: Hospital da Senhora da Oliveira; Rua dos Cutileiros, Creixomil. 4835-044 Guimarães, Portugal.Hospital da Senhora da Oliveira; Rua dos CutileirosCreixomil. 4835-044 GuimarãesPortugal

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Highlights

•	Non-alcoholic fatty liver disease (NAFLD) is independently associated with an increased risk of cardiovascular disease.
•	NAFLD should be addressed as a high cardiovascular risk profile predictor, such as Diabetes Mellitus, obesity, or smoking.
•	Transient elastography, through the controlled attenuated parameter (CAP), is a non-invasive, safe and cost-effective method to assess NAFLD.
•	Transient elastography may be key to address screening programs helping the stratification of the cardiovascular risk.
•	A CAP value above 295 dB/m independently increased the incidence of cardiovascular events up to 8-times.

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Abstract

Background

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Transient elastography (Fibroscan ®), by assessing the controlled attenuation parameter (CAP), is a non-invasive method able to accurately assess the presence and the grade of steatosis. Its hypothetical role in stratifying cardiovascular (CV) risk is unknown. We aim to assess the role of transient elastography, namely the CAP value, in the stratification of CV risk.

Methods

Cohort, retrospective study, including consecutive NAFLD patients that underwent Fibroscan®. Patients were followed at least one year. The correlation towards the outcome variable (cardiovascular event) was assessed with univariate and multivariate analysis.

Results

We included 96 NAFLD patients, 64 (66.7%) women, with a mean age of 48.9 years-old. Fifteen (15.6%) patients presented a cardiovascular event during follow-up. The statistically significant variables associated with cardiovascular event were introduced in a multivariable binary logistic regression model according to clinical importance. The following variables kept a statistically significant independent association with cardiovascular event: CAP > 295 dB/m (OR 8.661 CI 95% [1.119−67.028]; p value 0.039); type 2 diabetes mellitus (OR 20.236 CI 95% [2.815−145.461]; p value 0.003); dyslipidaemia (OR 14.647 CI 95% [1.261−170.189]; p value 0.032) and smoking (OR 8.946 CI 95% [1.347−59.431]; p value 0.023).

Conclusion

A CAP value above 295 dB/m independently increased the incidence of CV events up to 8-times. Transient elastography, through CAP, is a safe and cost-effective method to evaluate NAFLD, and should be considered in the stratification of CV risk.

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Keywords : Fibroscan, Controlled attenuated parameter, NAFLD, MAFLD, Cardiovascular risk