Non-alcoholic fatty liver disease, metabolic goal achievement with incident cardiovascular disease and eGFR-based chronic kidney disease in patients with prediabetes and diabetes.

Abstract

AIMS/HYPOTHESIS:

We aimed to evaluate the effect of NAFLD on the risk of incident cardiovascular disease (CVD) and estimated glomerular filtration rate (eGFR)-based chronic kidney disease (CKD), and further test the joint effects and interactions between NAFLD status and individual metabolic element, as well as the total 'ABCs' metabolic goal achievement, on the CVD and CKD risk among 101,296 patients with prediabetes or diabetes from a prospective cohort study.

METHODS:

We conducted the study based on the China Cardiometabolic Disease and Cancer Cohort (4C) study, a large-scale, population-based prospective cohort. After excluding alcohol abuse and other cause of hepatic diseases, we used fatty liver index (FLI) ≥ 60 as a proxy of NAFLD and stratified the probability of fibrosis by aspartate transaminase/alanine transaminase ratio (AAR) with cut-offs of 0.8 and 1.4. 'ABCs' metabolic goal was defined as subjects who had HbA1c < 6.5% (A), SBP/DBP < 130/80 mmHg (B), and LDL-C < 100 mg/dL (C). During 3.8 years follow-up, we validated 2340 CVD events based on medical records and identified 1943 participants developed CKD based on centrally tested eGFR.

RESULTS:

The multivariable adjusted hazard ratios (HRs) were 1.15 (95% confidence interval (CI), 1.05-1.27) for CVD events and 1.33 (95% CI, 1.20-1.48) for CKD among NAFLD patients, compared with participants without NAFLD. Of NAFLD patients, relative to individuals with low AAR (<0.8), those with high AAR (≥1.4) were more likely to experience CVD events [1.62 (1.21-2.18)] and CKD [1.63 (1.17-2.28)]. Participants with NAFLD and comorbid poorly controlled metabolic risk factors had higher risk of CVD events or CKD than having either alone, with a significant interaction between poor glycemic control and NAFLD on the risk of vascular complications.

CONCLUSIONS:

NAFLD was associated with incident CVD and CKD among patients with prediabetes or diabetes. Such associations were substantially modified by the comprehensive achievement of metabolic goal.

• Authors: Mian Li, Zhiyun Zhao, Guijun Qin, Li Chen, Jieli Lu, Yanan Huo, Lulu Chen, Tianshu Zeng, Min Xu, Yuhong Chen, Tiange Wang, Shuangyuan Wang, Yiping Xu, Lixin Shi, Xulei Tang, Qing Su, Xuefeng Yu, Li Yan, Qin Wan, Gang Chen, Zhengnan Gao, Guixia Wang, Feixia Shen, Zuojie Luo, Yinfei Zhang, Chao Liu, Youmin Wang, Ruying Hu, Zhen Ye, Shengli Wu, Huacong Deng, Tao Yang, Qiang Li, Yingfen Qin, Yiming Mu, Jiajun Zhao, Guang Ning, Yufang Bi, Yu Xu, Weiqing Wang
• Journal: Metabolism: clinical and experimental (Metabolism) Vol. 124 Pg. 154874 (11 2021) ISSN: 1532-8600 [Electronic] United States
• PMID: 34517014 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Cardiovascular Diseases (epidemiology, metabolism)
• China (epidemiology)
• Diabetes Mellitus, Type 2 (epidemiology, metabolism)
• Female
• Glomerular Filtration Rate (physiology)
• Humans
• Incidence
• Male
• Middle Aged
• Non-alcoholic Fatty Liver Disease (epidemiology, metabolism)
• Prediabetic State (epidemiology, metabolism)
• Renal Insufficiency, Chronic (epidemiology, metabolism)