Prognostic value of non-alcoholic fatty liver disease for predicting cardiovascular events in patients with diabetes mellitus with suspected coronary artery disease: a prospective cohort study.
Prognostic value of non-alcoholic fatty liver disease for predicting cardiovascular events in patients with diabetes mellitus with suspected coronary artery disease: a prospective cohort study.
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DOI：
10.1186/s12933-020-01192-4
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发表时间：
2021-01-07
影响因子：
9.3
通讯作者：
Ito H
中科院分区：
文献类型：
--
作者：
Ichikawa K;Miyoshi T;Osawa K;Miki T;Toda H;Ejiri K;Yoshida M;Nanba Y;Yoshida M;Nakamura K;Morita H;Ito H
尚未确定2型糖尿病（T2 DM）患者心血管事件的风险分层。冠状动脉钙化评分（CACS）和非酒精性脂肪肝（NAFLD）与T2 DM患者的心血管事件独立相关。本研究检查了通过非增强计算机断层扫描（CT）以及CACS和FRS评估的NAFLD对T2 DM患者心血管事件的增量预后价值。这项前瞻性初步研究纳入了529例无心血管疾病史的T2 DM门诊患者，这些患者因疑似冠状动脉疾病而接受了CACS测量。NAFLD在CT图像上定义为肝脏：脾脏衰减比< 1.0。心血管事件定义为心血管死亡、非致死性心肌梗死、晚期冠状动脉血运重建、非致死性卒中或因心力衰竭住院。在529例患者（61%男性，平均年龄65岁）中，143例（27%）被确定为NAFLD。在中位4.4年的随访期间记录了44例心血管事件。在多变量考克斯回归分析中，NAFLD、CACS和FRS与心血管事件相关（风险比和95%置信区间分别为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）。在CACS和FRS中加入NAFLD后，预测心血管事件的总χ2评分从27.0显著增加到49.7（p < 0.001）。将NAFLD添加到包括CACS和FRS的模型中，将C统计量从0.71显著增加到0.80（p = 0.005）。通过添加CACS和FRS实现的净重新分类为0.551（p < 0.001）。除CACS和FRS外，通过CT评估的NAFLD可能有助于识别心血管事件风险较高的T2 DM患者。
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. 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. 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 χ2 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). 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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影响因子：
16.2
作者：
Agarwal S;Cox AJ;Herrington DM;Jorgensen NW;Xu J;Freedman BI;Carr JJ;Bowden DW
通讯作者：
Bowden DW
非酒精性脂肪肝病与冠状动脉钙化有关。
影响因子：
13.5
作者：
Kim, Donghee;Choi, Su-Yeon;Park, Eun Ha;Lee, Whal;Kang, Jin Hwa;Kim, Won;Kim, Yoon Jun;Yoon, Jung-Hwan;Jeong, Sook Hyang;Lee, Dong Ho;Lee, Hyo-suk;Larson, Joseph;Therneau, Terry M.;Kim, W. Ray
通讯作者：
Kim, W. Ray
影响因子：
4.5
作者：
Idilman, Ilkay S.;Akata, Deniz;Karcaaltincaba, Musturay
通讯作者：
Karcaaltincaba, Musturay
影响因子：
16.2
作者：
Fox, CS;Sullivan, L;Wilson, PWF
通讯作者：
Wilson, PWF
影响因子：
5.5
作者：
Ma, Xiaozhou;Holalkere, Nagaraj-Setty;Sahani, Dushyant V.
通讯作者：
Sahani, Dushyant V.