10-Year Atherosclerotic Cardiovascular Disease Risk Scores in Patients With Nonalcoholic Fatty Liver Disease and Sex Differences

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

10-2023

DOI

10.14309/01.ajg.0000955356.41831.9e

Journal Title

American Journal of Gastroenterology

Department

Medicine

Abstract

Introduction:

Non-alcoholic fatty liver disease (NAFLD) is increasing in prevalence in the US. NAFLD shares risk factors with atherosclerotic cardiovascular disease (ASCVD). The 10-year ASCVD risk score is traditionally used in patients over 40 years of age to make a recommendation for statin use to reduce the risk of future cardiovascular events. It is currently unclear how ASCVD risk scores are distributed in patients with NAFLD and if there are sex differences.

Methods:

We used the National Health and Nutrition Examination Survey (NHANES) database (2017– March 2020) to identify patients with NAFLD. NAFLD was identified by transient elastography (FibroScan®) data, by using controlled attenuation parameter ≥302 dB/m using Youden’s index. In the final NAFLD sample, ASCVD 10-year risk scores were calculated by identifying individual components of the ASCVD equation including sex, race, presence of diabetes mellitus, taking hypertension medications, smoking status, systolic blood pressure, total cholesterol and high-density lipoprotein cholesterol levels.

Results:

We studied 986 patients with NAFLD and age > = 40 years. Mean patient age was 61+- 11 years, 50.7% study population was female, and 20.5% individuals were of non-Hispanic Black race. The mean 10-year ASCVD risk score was 4.5%+-46% and the median score was 14% [IQR 24% – 40%]. Overall, 32% patients had ASCVD score < 7.5% (statin not recommended for primary prevention of cardiovascular events), 29 % had scores 7.5%-19.9% (statin to be considered based on shared decision making and considering other risk factors), and 38.9% had 10-year ASCVD risk score >20% (strong recommendation for statin prescription). When stratified by sex, more females than males had a ASCVD score < 7.5% (40% vs 23%; P < 0.01).

Conclusion:

The majority of patients with NAFLD have a high risk for ASCVD events. Around a third of patients are considered low ASCVD risk based on the 10-year risk score and do not meet criteria for statin prescription for primary prevention, and this proportion was higher in females (4 in 10 patients). Future sex specific outcome studies to evaluate the role of NAFLD as an independent risk factor for ASCVD events could support statin prescription in most patients with NAFLD to improve cardiovascular health.

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