The Emerging Epidemic of Nonalcoholic Fatty Liver Disease and Cardiovascular Risk: True, True, and Related?
The Emerging Epidemic of Nonalcoholic Fatty Liver Disease and Cardiovascular Risk: True, True, and Related?
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新出现的非酒精性脂肪肝与心血管风险的流行：真实、真实和相关吗？
DOI：
10.1007/s10620-020-06113-9
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发表时间：
2020
影响因子：
3.1
通讯作者：
Litwin,SheldonE
中科院分区：
文献类型：
--
作者：
Morningstar,JordanE;Syn,Wing-Kin;Litwin,SheldonE
非酒精性脂肪性肝病（NAFLD）是一种影响超过30%美国人的疾病，是肝移植的主要适应症之一。非酒精性脂肪肝的患病率已经超过了肥胖和代谢综合征发病率的上升。一项研究发现，肥胖患者的NAFLD患病率是正常体重患者的7倍以上[1]。由于几项研究已经证明NAFLD与心血管事件风险增加之间存在关联，因此有人提出NAFLD可能是动脉粥样硬化的独立风险因素[2]。尽管由于经常存在共同的风险因素（即肥胖、糖尿病和血脂异常），很难分析NAFLD与心血管疾病（CVD）之间的关联，但NAFLD，特别是伴有纤维化的非酒精性脂肪性肝炎（NASH）的更晚期疾病，与CVD风险增加相关，与传统风险因素无关[2]。其他研究对这一发现提出质疑，表明NAFLD患者的CVD仅仅是由于增加心血管风险的公认特征的较高患病率[3]，无论潜在机制如何，CVD被认为是NAFLD患者死亡的主要原因[4]。Labenz等人在德国初级保健实践的大型管理数据库中确定了NAFLD与CVD之间的关联[5]。在这项研究中，CVD被定义为偶发性心肌梗死（MI）、冠心病（CHD）、房颤（AF）和卒中。在22，048例诊断为NAFLD的患者样本中，与没有这种诊断的匹配队列相比，他们证明了NAFLD和CVD之间的关联存在，尽管协变量匹配，包括年龄，性别，糖尿病，高血压和高脂血症。尽管有统计学意义，但绝对风险相当适中，NAFLD组MI发生率为2.9%，对照组为2.3%。作者指出，尽管估计NAFLD在德国的患病率为25%，但仅3%的分析队列诊断为NAFLD，这突出了现有医疗保健系统对NAFLD的认识不足和/或管理数据库的问题。这篇文章提出了一些关于NAFLD和CVD的重要问题。
Nonalcoholic fatty liver disease (NAFLD), a condition that affects over 30% of Americans, is one of the leading indications for liver transplantation. The prevalence of NAFLD has paralleled the rising rates of obesity and the metabolic syndrome. One study found that the prevalence of NAFLD was over seven times higher in patients who were obese compared to those with normal weight [1]. Since several studies have demonstrated an association between NAFLD and an increased risk of cardiovascular events, it has been proposed that NAFLD may be an independent risk factor for atherosclerosis [2]. Although it is difficult to dissect the association between NAFLD and cardiovascular disease (CVD) due to the frequent presence of shared risk factors (ie, obesity, diabetes, and dyslipidemia), NAFLD, and in particular the more advanced condition of nonalcoholic steatohepatitis (NASH) with fibrosis, is associated with an increased risk of CVD that is independent of traditional risk factors [2]. Other studies dispute this finding, suggesting that CVD in NAFLD patients is solely due to a higher prevalence of acknowledged traits that increase cardiovascular risk [3] Regardless of the underlying mechanisms, CVD is thought to be the leading cause of death in patients with NAFLD [4].In the current issue of Digestive Diseases and Sciences, Labenz et al. identified an association between NAFLD and CVD in a large administrative database of primary care practices in Germany [5]. In this study, CVD was defined as incident myocardial infarction (MI), coronary heart disease (CHD), atrial fibrillation (AF), and stroke. In a sample of 22,048 patients with a diagnosis of NAFLD compared with a matched cohort without this diagnosis, they demonstrated that the association between NAFLD and CVD was present despite matching for covariates including age, sex, diabetes, hypertension, and hyperlipidemia. Although statistically significant, the absolute risk was fairly modest with 2.9% incidence of MI in the NAFLD group versus 2.3% in the control group. The authors pointed out that although NAFLD is estimated to have a prevalence of 25% in Germany, just 3% of the analyzed cohort had a diagnosis of NAFLD, highlighting the underrecognition of NAFLD in existing healthcare systems and/or problems with administrative databases. The article raises a number of important questions regarding NAFLD and CVD.