NAFLD with liver fibrosis tied to heightened 10-year CVD risk among type 1 diabetes patients

NAFLD (non-alcoholic fatty liver disease) has become a widespread and fast-growing public health threat, leading to substantial economic and social costs and reduced health-related quality of life. About a third of the world's adult population is affected by NAFLD, up to people with type 2 diabetes mellitus (T2DM), and up to ~ 40% of adults with T1DM.

Alessandro Mantovani, University of Verona, Verona, Italy, and colleagues assessed whether hepatic steatosis with or without significant fibrosis (determined by validated non-invasive biomarkers) is linked with an increased 10-year estimated risk for CVD in patients with type 1 diabetes mellitus.

For this purpose, the researchers conducted a cross-sectional, multicenter, retrospective study involving 1,254 adults with established T1DM without pre-existing CVD. Hepatic steatosis index (HSI) and fibrosis (FIB)-4 index was used for the non-invasive detection of hepatic steatosis (defined as HSI > 36), with or without coexisting significant fibrosis (defined as FIB-4 index ≥ 1.3 or < 1.3).

Steno type 1 risk engine and the atherosclerotic CVD (ASCVD) risk score was calculated to estimate the 10-year risk of developing a first fatal or nonfatal CVD event.

The study revealed the following findings:

· Using the Steno type 1 risk engine, a significantly greater proportion of patients with hepatic steatosis and significant fibrosis (n = 91) had a high 10-year estimated CVD risk compared to those with hepatic steatosis alone (n = 509) or without steatosis (n = 654) (75.8% versus 23.2% versus 24.9%).

· After adjustment for BMI, sex, haemoglobin A1c, diabetes duration, chronic kidney disease, and lipid-lowering medication use, patients with hepatic steatosis and significant fibrosis had an increased 10-year estimated risk of developing a first fatal or nonfatal CVD event (adjusted-odds ratio 11.4) than those without steatosis.

· Almost identical results were observed using the ASCVD risk calculator.

The study findings from the large multicenter cross-sectional study comprising patients with type 1 diabetes without preexisting CVD revealed that NAFLD with liver fibrosis was significantly associated with an elevated 10-year estimated risk of developing a first fatal or nonfatal CVD event. Even after adjustments for common diabetes-related variables, CVD risk factors, and other potential confounders, the association remained significant.

"There is a need for further research to corroborate these findings in other cohorts of individuals with type 1 diabetes from different countries and to better elucidate whether the non-invasive NAFLD detection with varying levels of liver fibrosis could improve CVD risk prediction in T1DM patients," the researchers wrote.

They added, "In the meantime, we believe that using CVD risk prediction models is a critical step to support the clinical decision on the primary prevention in T1DM patients."

"In addition, a multidisciplinary, team-based approach to treating people with T1DM and advanced NAFLD, based on a careful evaluation of related risk factors and monitoring for CVD and liver complications, is warranted," they concluded.

Reference:

Mantovani, A., Morieri, M.L., Palmisano, L. et al. Hepatic steatosis with significant fibrosis is associated with an increased 10-year estimated risk of cardiovascular disease in adults with type 1 diabetes mellitus. Cardiovasc Diabetol 22, 204 (2023). https://doi.org/10.1186/s12933-023-01945-x