Liver and Bile
Hepatology. 2022;76(5):1495–505
Risk of cardiovascular disease and loss in life expectancy in NAFLD
Background and aims: Conflicting evidence exists on cardiovascular disease (CVD) risk in patients with non-alcoholic fatty liver disease (NAFLD), and data are lacking on whether NAFLD increases mortality after a CVD event. Moreover, life expectancy in NAFLD has not been studied. The authors therefore examined CVD risk and life expectancy in patients with NAFLD compared with the general population.
Approach and results: In this nationwide population-based cohort, all patients with NAFLD diagnosis and without baseline CVD (ascertaining from the Swedish National Patient Register from 1987 to 2016, n = 10,023) were matched 10:1 on age, sex, and municipality to individuals from the general population (controls, n = 96,313). CVD diagnosis and mortality were derived from national registers. Multistate models and flexible parametric survival models were used to estimate adjusted hazard ratios (aHRs) for CVD risk and loss in life expectancy due to NAFLD. The authors identified 1037 (10.3%) CVD events in patients with NAFLD and 4041 (4.2%) in controls. CVD risk was 2.6-fold higher in NAFLD compared with controls (aHR = 2.61, 95% confidence interval [CI]: 2.36–2.88) and was strongest for non-fatal CVD (aHR = 3.71, 95% CI: 3.29–4.17). After a non-fatal CVD event, the risk for all-cause mortality was similar between patients with NAFLD and controls (aHR = 0.89, 95% CI: 0.64–1.25). Life expectancy in patients with NAFLD was, on average, 2.8 years lower than controls, with the highest loss of life-years when NAFLD was diagnosed in middle age (40–60 years).
Conclusions: Non-alcoholic fatty liver disease (NAFLD) was associated with a higher risk of non-fatal cardiovascular disease (CVD) but did not affect post-CVD mortality risk. Patients diagnosed with NAFLD have a lower life expectancy than the general population.