Home Medizin Das Risiko einer nichtalkoholischen Fettlebererkrankung führt zu Herz-Kreislauf-Erkrankungen und führt bei Patienten mit Typ-2-Diabetes mellitus zum Tod

Das Risiko einer nichtalkoholischen Fettlebererkrankung führt zu Herz-Kreislauf-Erkrankungen und führt bei Patienten mit Typ-2-Diabetes mellitus zum Tod

von NFI Redaktion

In a recent study published in the British Medical Journal, researchers investigated the link between non-alcoholic fatty liver disease (NAFLD) in individuals with type 2 diabetes mellitus (T2DM) and the risk of overall mortality and cardiovascular diseases (CVD). They discovered that individuals with NAFLD and T2DM have an increased risk of CVD and overall mortality.

Study: Link between non-alcoholic fatty liver disease and cardiovascular diseases leading to death in patients with type 2 diabetes mellitus: a nationwide population-based study. Image credit: Explode/Shutterstock.com
Image credit: Explode/Shutterstock.com

Background

The prevalence of NAFLD is increasing globally, often accompanied by metabolic disorders that result in insulin resistance. It poses a significant health risk, leading to liver complications and cardiovascular diseases, which are one of the leading causes of death, particularly among NAFLD patients.

T2DM is a major risk factor for cardiovascular diseases and is closely linked to a higher prevalence and severity of NAFLD. The complex relationship between NAFLD and T2DM suggests a synergistic effect on cardiovascular risk, as a significant proportion of T2DM patients also suffer from NAFLD. However, studies examining their correlation with cardiovascular diseases have yielded mixed results. While some found no correlation, others showed a twofold higher risk of cardiovascular diseases in T2DM patients with NAFLD compared to those without NAFLD. Furthermore, earlier studies were limited by their cross-sectional designs and small sample sizes.

To address this gap, the researchers in the present study aimed to evaluate the risk associated with NAFLD for cardiovascular diseases and overall mortality in T2DM patients using a large-scale population-based longitudinal approach.

Study Details

This nationwide cohort study utilized data from the National Health Information Database linked with the National Health Screening Program. The exclusion criteria included age ≤ 20 years, consumption of ≥ 30 g/day of alcohol, missing data, or a history of type 1 diabetes mellitus, chronic hepatitis B and C, liver cirrhosis, hepatocellular carcinoma, or CVD. Additionally, patients who experienced a cardiovascular disease within one year were also excluded.

A total of 7,796,763 participants were selected, and the endpoint was the occurrence of deaths from any cause, cardiovascular diseases, or until December 31, 2018. Cardiovascular diseases included myocardial infarction or ischemic stroke, confirmed by hospital admissions with relevant claims for brain magnetic resonance imaging or computed tomography. The average follow-up time for the patients was 8.13 years.

Anthropometric measurements and laboratory parameters were collected. Blood pressure was measured in a sitting position, and fasting venous blood samples were taken to determine various parameters, including glucose, liver enzymes, lipid profile, and creatinine levels. Additionally, the estimated glomerular filtration rate was determined.

Information on lifestyle factors such as smoking, alcohol consumption, regular exercise, and socioeconomic status was collected through a standardized self-assessment questionnaire. Statistical methods included Cox proportional hazards models adjusted for various factors, Kaplan-Meier survival curves, and subgroup analyses.

Results and Discussion

Among the participants, 6.49% had T2DM. NAFLD Grade 1 and 2 were identified in 22.04% and 11.11% of the participants, respectively. A higher proportion of T2DM patients had NAFLD Grade 2 (26.73%) and NAFLD Grade 1 (34.06%) compared to those without T2DM. Among the participants with T2DM, 6.77% had a cardiovascular disease, and approximately 8.38% of the participants died. In contrast, 2.24% of the participants without T2DM had a cardiovascular disease, and approximately 2.71% of the participants died.

The incidence rates for cardiovascular diseases, myocardial infarctions, ischemic strokes, and overall mortality increased with the severity of NAFLD and were higher in patients with T2DM than in those without. The hazard ratios for these outcomes were also higher in NAFLD Grade 1 and 2 compared to non-NAFLD, regardless of T2DM status. Furthermore, the absolute five-year risk for these outcomes increased with the severity of NAFLD, especially in patients with T2DM. The risk differences for cardiovascular diseases, myocardial infarction, ischemic stroke, and all-cause death were higher between non-NAFLD and NAFLD Grade 2 than between non-NAFLD and NAFLD Grade 1. Additionally, these risk differences were higher in patients with T2DM than in those without T2DM.

NAFLD was associated with an increased risk for cardiovascular diseases, myocardial infarction, ischemic stroke, and overall mortality in both T2DM and non-T2DM patients (p<0.001). Among NAFLD patients, those with NAFLD Grade 2 had the highest risk, followed by NAFLD Grade 1.

Furthermore, the incidence rates of cardiovascular diseases, myocardial infarctions, ischemic strokes, and all-cause deaths increased sequentially from non-NAFLD to NAFLD Grade 1 and to NAFLD Grade 2 in all age groups, with higher rates observed in T2DM patients.

The study’s limitations include the use of the fatty liver index for NAFLD definition, the lack of assessment of glycated hemoglobin variability and changes in diabetes medications, the limited generalizability to other ethnicities, and the inability to evaluate liver fibrosis.

Conclusion

In conclusion, individuals with T2DM and even mild NAFLD have a higher risk of cardiovascular diseases and overall mortality. The risk gap between non-NAFLD and NAFLD Grade 1 or Grade 2 is more significant in T2DM patients than in patients without NAFLD. The results underscore the need for NAFLD screening and prevention in T2DM patients to reduce subsequent cardiovascular risk and mortality.

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