Higher CV morbidity and mortality risk for hospitalized patients with T2DM and NAFLD

EASD 2017 Scottish population-based data reveal that hospitalized people with T2DM and non-alcoholic fatty liver disease have an increased risk of CVD events and CV and all-cause mortality.

Presented by Sarah Wild (University of Edinburgh, UK ) at the European Association for the Study of Diabetes (EASD) Annual Meeting in Lisbon, Portugal (11-15 September).

Non-alcoholic fatty liver disease (NAFLD) affects around three-quarters of obese adults with type 2 diabetes (T2DM). The Scottish Diabetes Research Network presented their findings that hospital admission with NAFLD is associated with an increased risk of developing and dying from cardiovascular diseases (CVDs) such as heart failure or a heart attack.

Previous research has shown that there is a link between NAFLD and CVD, but until now it was unclear if the same was true in people T2DM. Using hospital and death record data, Professor Sarah Wild from the University of Edinburgh, UK, and Professor Christopher Byrne from the University of Southampton, UK, therefore explored the connection between NAFLD and CVD or death in over 133300 adults diagnosed with T2DM in Scotland between 2004 and 2013 who had at least one hospital admission.

NAFLD was mentioned in hospital records for 1998 people over the average 4.7-year follow-up period. At the time of diabetes diagnosis, people with NAFLD had different patterns of other risk factors for CVD and death in that they were younger (60.0 vs 62.7 years), more likely to be women (49% vs 45%), more likely to be current smokers (25% vs 22%), and they had higher BMI (32.9 vs 32.1 kg/m2) and HbA1c (64 vs 62 mmol/l). The authors suggest these factors could be interlinked in many cases.

The analysis showed that NAFLD was associated with around a 62% increase in incident or recurrent CVD (stroke or myocardial infarction, HR: 1.62, 95%CI: 1.47-1.77) compared to those without the condition, which appeared to be independent of other influential factors such as age, sex, socio-economic status, smoking, high blood pressure, high cholesterol, blood sugar as measured by HbA1c, and CVD at diabetes diagnosis. NAFLD was also independently associated with a 39% increased risk of CV death (HR: 1.39, 95%CI: 1.10-1.74), a doubling of the risk of death from any cause (HR: 2.11, 95%CI: 1.92-2.32), and a 41-fold increase in death from liver cancer (hepatocellular carcinoma [HCC}, HR: 41.9, 95%CI: 27.1-64.8). Risk of any cancer (excluding HCC) was not significantly increased (HR: 1.15, 95%CI: 0.92-1.42).

Thus, NAFLD is an independent risk factor for increased mortality and incident/recurrent CVD evens in people with T2DM. The authors conclude: “Because non-alcoholic fatty liver independently raises the risk of cardiovascular disease and mortality in people with type 2 diabetes, preventing the condition by avoiding unhealthy lifestyles in people with diabetes is vital. Losing weight through diet and exercise can prevent and treat the early stages of NAFLD in obese people with diabetes, and obesity surgery has been shown to ameliorate the early stages of the condition. However, effective and safe treatments are also urgently needed.”

//- Our reporting is based on the information provided by the EASD press service -//