80-OR: Association of Nonalcoholic Fatty Liver Disease and Liver Fibrosis with Cardiovascular Disease, All-Cause, and Cause-Specific Mortality in Individuals with Type 2 Diabetes

• Published in: Diabetes (New York, N.Y.) Vol. 73; p. 1
• Main Authors: Xu, Shaoyong, You, Qiqi, Liu, Longfu
• Format: Journal Article
• Language: English
• Published: New York American Diabetes Association 01.06.2024
• Subjects: Cardiovascular disease; Cardiovascular diseases; Congestive heart failure; Coronary artery disease; Diabetes; Diabetes mellitus (non-insulin dependent); Fatty liver; Fibrosis; Heart diseases; Heart failure; Liver cirrhosis; Liver diseases; Mortality
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/db24-80-OR

Introduction & Objective: The presence of NAFLD has been shown to significantly increase the risk of CVD and mortality, but their clarity in individuals with T2DM remains unclear. We aim to explore whether NAFLD and liver fibrosis affect CVD risk, all-cause and cause-specific mortality in individuals with T2DM. Methods: This population-based cohort analyzed data of 14,990 individuals with T2DM from the UK biobank. NAFLD was identified by fatty liver index (FLI), and liver fibrosis was identified by BARD, Fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS). Cox models were used to estimate the associations of NAFLD and liver fibrosis with CVD, all-cause and cause-specific mortality. Results: Among 14,990 participants with T2DM (mean [SD] age, 58.7 [7.4] years; 8 237 [54.9%] men), there were 1,429 coronary heart disease, 985 heart failure, 595 stroke and 1,904 deaths. NAFLD was associated with an increased risk of coronary heart disease (HR: 1.65, 95% CI: 1.22-2.23), and a high FLI (quartile 4) was linked to a 110% higher risk of heart failure (95% CI: 1.52-2.90), a 91% higher risk of all-cause mortality (95% CI: 1.54-2.39), and an 83% higher risk of cancer mortality (95% CI: 1.30-2.59). Participants at high risk for fibrosis had a significantly higher risk of all-cause mortality than those at low risk for fibrosis (BARD, HR: 1.65, 95% CI: 1.14-2.38; FIB-4, HR: 1.68, 95% CI: 1.37-2.06; NFS, HR: 1.49, 95% CI: 1.29-1.73). A high risk for fibrosis determined by the NFS and FIB-4 was also linked with higher risks of mortality from CVD (HR: 1.59, 95% CI: 1.17-2.15) and cancer (HR: 1.53, 95% CI: 1.09-2.16), respectively. Conclusion: These findings suggest that NAFLD and liver fibrosis are associated with elevated risks of major CVD, all-cause and cause-specific mortality in individuals with T2DM. Assessing individuals with T2DM for the presence and progression of NAFLD during clinical consultations is recommended.