NAFLD independent predictor of Increased CVD and all cause mortality after MI

In a groundbreaking study conducted in the Netherlands, researchers have uncovered a critical connection between Non-Alcoholic Fatty Liver Disease (NAFLD) and the risk of cardiovascular disease (CVD) mortality in patients with a history of myocardial infarction (MI). As accumulating evidence hints at NAFLD's potential role in both the onset and progression of CVD, this investigation aimed to shed light on the 12-year risk of CVD and all-cause mortality in post-MI patients by utilizing the Fatty Liver Index (FLI) as an indicator of NAFLD. 

The study results were published in the journal PLOS ONE on September 8, 2023. 

Myocardial infarction (MI) is one of the most common causes of CVD, which is the world's leading cause of death. Despite the decrease in the mortality rates in some countries, there is a steady increase in the number of patients with prevalent CVD due to the increase in the prevalence of metabolic diseases. NAFLD, also known as non-alcoholic fatty liver disease, is thought to be the hepatic manifestation of the metabolic syndrome. The fatty liver index is used as a predictor of NAFLD. Evidence shows that NAFLD might play a role in the etiology and progression of CVD. Hence researchers from the Netherlands conducted a study to assess the relationship between the Fatty Liver Index (FLI), as an indicator for non-alcoholic fatty liver disease (NAFLD), with 12-year risk of cardiovascular disease (CVD) and all-cause mortality in post-MI patients. 

A research team led by Luc Heerkens carried out the study by involving 4165 Dutch patients from the Alpha Omega Cohort, aged 60 to 80 years, who had experienced a myocardial infarction (MI) within the last decade. The study assessed NAFLD status using the Fatty Liver Index (FLI), with a threshold of FLI ≥60 indicating the presence of NAFLD. These patients were then closely monitored for cause-specific mortality from their enrollment in the study between 2002 and 2006 until December 2018.

Notable findings: 

• The median FLI score among the participants was 68, with 60% of them showing FLI scores ≥60.
• This group, which had NAFLD, was characterized by a higher proportion of males and a greater prevalence of conditions like diabetes, high blood pressure, and elevated serum cholesterol levels. 
• Over the 12-year follow-up period, there were a total of 2042 deaths, of which 846 were attributed to CVD.
• Strikingly, patients with NAFLD were found to be at a significantly higher risk of CVD mortality, with a Hazard Ratio (HR) of 1.55, and all-cause mortality, with an HR of 1.21, when compared to patients without NAFLD.
• Notably, these results remained consistent even after excluding patients with obesity and diabetes from the analysis.

In summary, this study revealed that a FLI score of ≥60, indicating the presence of NAFLD, was a strong predictor of both CVD and all-cause mortality in post-MI patients, independent of other cardiometabolic risk factors. Furthermore, the study suggests that the cutoff points for predicting CVD mortality may differ between male and female patients, with females showing a stronger adverse association between FLI and CVD mortality.

Further reading: Heerkens L, van Kleef LA, de Knegt RJ, Voortman T, Geleijnse JM. Fatty Liver Index and mortality after myocardial infarction: A prospective analysis in the Alpha Omega Cohort. PLoS One. 2023;18(9):e0287467. Published 2023 Sep 8. doi:10.1371/journal.pone.0287467