Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: A meta-analysis
Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: A meta-analysis
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DOI：
10.1016/j.jhep.2016.05.013
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发表时间：
2016-09-01
影响因子：
25.7
通讯作者：
Barbui, Corrado
中科院分区：
文献类型：
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作者：
Targher, Giovanni;Byrne, Christopher D.;Barbui, Corrado
背景和目标：已经有许多关于非酒精性脂肪性肝病（NAFLD）和心血管疾病（CVD）风险的研究，但这些研究产生了相互矛盾的结果。我们对这些研究进行了荟萃分析，以量化NAFLD（和NAFLD严重程度）与CVD事件风险之间的关联程度。方法：我们使用术语“NAFLD”、“心血管事件”、“心血管死亡率”、“预后”及其组合检索PubMed、Google scholar和Web of Science数据库，以确定截至2016年1月发表的观察性研究。我们仅纳入了在> 18岁的成人中进行的观察性研究，其中NAFLD是通过影像学或组织学诊断的。从选定的研究中提取数据，然后进行荟萃分析，使用随机效应modeling.Results：一个独特的，观察性前瞻性和回顾性研究共16个34,043成人个体（36.3%与NAFLD）和约2,600心血管疾病的结果（>70%心血管疾病死亡）超过6.9年的中位数期间被纳入最终分析。NAFLD患者发生致死性和/或非致死性CVD事件的风险高于非NAFLD患者（随机效应比值比[OR] 1.64，95% CI 1.26-2.13）。更严重的NAFLD患者也更有可能发生致命性和非致命性CVD事件（OR 2.58; 1.78-3.75）。敏感性分析没有改变这些结果。漏斗图和Egger检验未发现显著的发表偏倚。结论：NAFLD与致死性和非致死性心血管事件的风险增加相关。然而，纳入研究的观察性设计不允许得出明确的因果关系inferences.Lay总结：关于NAFLD本身是否与心血管事件和死亡增加相关的数据仍然是一个争论的问题。这项更新的大型观察性研究荟萃分析的结果表明，NAFLD与致死性和非致死性心血管事件的风险增加显著相关。然而，纳入研究的观察性设计并不能证明NAFLD会导致心血管疾病。管理NAFLD患者的临床医生不应该只关注肝脏疾病，还应该考虑心血管疾病风险的增加，并进行早期，积极的风险因素调整。(C)2016年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background & Aims: There have been many studies of the effects of non-alcoholic fatty liver disease (NAFLD) and the risk of cardiovascular disease (CVD), but these have produced conflicting results. We performed a meta-analysis of these studies to quantify the magnitude of the association between NAFLD (and NAFLD severity) and risk of CVD events.Methods: We searched PubMed, Google scholar, and Web of Science databases using terms "NAFLD", "cardiovascular events", "cardiovascular mortality", "prognosis" and their combinations to identify observational studies published through January 2016. We included only observational studies conducted in adults > 18 years and in which NAFLD was diagnosed on imaging or histology. Data from selected studies were extracted and meta-analysis was then performed using random effects modelling.Results: A total of 16 unique, observational prospective and retrospective studies with 34,043 adult individuals (36.3% with NAFLD) and approximately 2,600 CVD outcomes (>70% CVD deaths) over a median period of 6.9 years were included in the final analysis. Patients with NAFLD had a higher risk of fatal and/or non-fatal CVD events than those without NAFLD (random effect odds ratio [OR] 1.64, 95% CI 1.26-2.13). Patients with more 'severe' NAFLD were also more likely to develop fatal and non-fatal CVD events (OR 2.58; 1.78-3.75). Sensitivity analyses did not alter these findings. Funnel plot and Egger's test did not reveal significant publication bias.Conclusions: NAFLD is associated with an increased risk of fatal and non-fatal CVD events. However, the observational design of the studies included does not allow to draw definitive causal inferences.Lay summary: The data on whether NAFLD by itself is associated with increased cardiovascular events and death remains an issue of debate. The findings of this updated and large meta-analysis of observational studies indicate that NAFLD is significantly associated with an increased risk of fatal and non-fatal cardiovascular events. However, the observational design of the studies included does not allow us to prove that NAFLD causes cardiovascular disease. Clinicians who manage patients with NAFLD should not focus only on liver disease but should also consider the increased risk of cardiovascular disease and undertake early, aggressive risk factor modification. (C) 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.