Summary Aim Recent studies reported an association between nonalcoholic fatty liver disease (NAFLD) and an increased risk of new-onset heart failure (HF). However, the magnitude of the risk and whether this risk changes with the severity of liver disease remains uncertain. We performed a meta-analysis of observational studies to quantify the magnitude of the association between NAFLD and the risk of new-onset HF. Design We systematically searched Scopus, Web of Science, and PubMed from database inception to March 2022 to identify eligible observational studies, in which NAFLD was diagnosed by serum biomarkers/scores, International Classification of Diseases (ICD) codes. , imaging techniques or liver histology. The primary outcome was new-onset heart failure, assessed primarily by ICD codes. Data were extracted from selected studies and meta-analysis was performed using random-effects models to obtain summary hazard ratios (HRs) with 95% CIs. Results We identified 11 longitudinal cohort studies with aggregated data on 11,242,231 middle-aged people from different countries and 97,716 cases of incident HF over a median of 10 years. NAFLD was associated with a moderately increased risk of new-onset HF (pooled random effects hazard ratio 1.50, 95% CI 1.34 to 1.67, p<0.0001; I2=94.8 %). This risk was independent of age, sex, ethnicity, measures of adiposity, diabetes, hypertension, and other common cardiovascular risk factors. Sensitivity analyzes did not change these results. The funnel plot did not show any significant publication bias. Conclusion NAFLD is associated with a 1.5-fold increased long-term risk of new-onset HF, independent of the presence of diabetes, hypertension, and other common cardiovascular risk factors. However, the observational design of the studies does not allow causality to be demonstrated. |
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Fat buildup in the liver, known as nonalcoholic fatty liver disease, or NAFLD for short, is linked to an increased risk of heart failure over the next decade, according to a pooled data analysis of available research, published online . in Gut magazine.
NAFLD has become one of the most common causes of chronic liver disease worldwide, affecting up to around 30% of adults. Its global prevalence is expected to increase significantly over the next decade as a result of increasing levels of overweight and obesity.
Recently published studies have implicated NAFLD in the development of heart failure, when the heart is unable to pump sufficient amounts of blood throughout the body. But the size of this risk, and whether it differs depending on the severity of liver disease, is unclear.
To try to find out, researchers combined results from 11 international long-term observational studies published through March 2022. The studies looked at possible links between NAFLD and heart failure among more than 11 million middle-aged adults.
Four studies were conducted in Sweden, Finland and the United Kingdom; four were made in the US; and three took place in South Korea.
Half of the study participants were women, with an average age of 55 and an average BMI (body mass index) of 26: a BMI between 18.5 and 24.9 indicates a healthy weight; 25 and 29.9 indicates overweight; and a BMI of 30 or higher indicates obesity.
About 1 in 4 (2.9 million; 26%) of study participants already had NAFLD. Heart failure was diagnosed in 97,716 during an average follow-up period of 10 years.
Pooled data analysis of the results from all 11 studies showed that the presence of NAFLD was associated with a 50% increase in the risk of developing heart failure during the follow-up period. This was independent of age, sex, body fat, diabetes, high blood pressure, ethnicity and other common cardiovascular risk factors.
To overcome the inherent problems associated with different study designs and methods, the researchers combined data from studies selected by country of study, length of follow-up period, method of heart failure diagnosis, and method of NAFLD diagnosis: the results remained consistent. the same.
The risk also appeared to increase in parallel with the severity of NAFLD, especially with more extensive liver fibrosis (scarring), when the risk was 76% higher, although this finding was based on findings from only 2 studies.
It’s unclear exactly how NAFLD might increase the risk of cardiac complications involved in developing heart failure, researchers say. But NAFLD worsens systemic insulin resistance, promotes plaque formation, and releases a cocktail of inflammatory and blood-thickening chemicals, they explain.
And newer diabetes medications, which lower blood glucose, appear to have some favorable effects on the risks of hospital admission for heart failure, they add.
The researchers recognize several limitations in the analysis of pooled data, among which the observational nature of the included studies stands out, which prevents establishing causality.
But their findings echo previously published research, and suggest that anyone with NAFLD deserves careful medical monitoring because of the link between this condition and heart failure.
