Advanced fibrosis is associated with incident cardiovascular disease in patients with non-alcoholic fatty liver disease.

Journal Article (Journal Article)


Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular disease. It is not well understood, however, which individuals with NAFLD are at highest risk for cardiovascular disease.


To determine the factors associated with incident cardiovascular events in a prospective cohort of individuals with biopsy-proven NAFLD without pre-existing cardiovascular disease.


From 2011 to 2018, adults with biopsy-proven NAFLD without cardiovascular disease were enrolled in a tissue repository and were followed prospectively to the first recorded date of incident cardiovascular disease, death or the end of follow-up (11/1/2018). Competing risks analysis was performed to identify predictors of incident cardiovascular disease.


After a median follow-up time of 5.2 years, 26/285 (9.1%) individuals experienced an incident cardiovascular event. Advanced fibrosis (stage 3-4) on biopsy was a significant predictor of incident cardiovascular disease, and this persisted on multivariable analysis (SHR 2.86, 95% CI 1.36-6.04) after considering relevant covariates, including cardiovascular risk scores, which were not independent predictors. Of the non-invasive indicators of fibrosis, the NAFLD fibrosis score was the only independent predictor of cardiovascular disease. Other histologic features, including steatohepatitis, were not associated with incident cardiovascular disease.


In adults with biopsy-proven NAFLD, advanced fibrosis on biopsy and higher NAFLD fibrosis score were significant and independent predictors of incident cardiovascular disease, even after considering traditional risk factors and cardiovascular risk scores. These findings should be considered when evaluating NAFLD patients for primary prevention of cardiovascular disease, and further evaluation into the link between advanced fibrosis and cardiovascular disease is needed.

Full Text

Duke Authors

Cited Authors

  • Henson, JB; Simon, TG; Kaplan, A; Osganian, S; Masia, R; Corey, KE

Published Date

  • April 2020

Published In

Volume / Issue

  • 51 / 7

Start / End Page

  • 728 - 736

PubMed ID

  • 32043602

Pubmed Central ID

  • PMC7069774

Electronic International Standard Serial Number (EISSN)

  • 1365-2036

International Standard Serial Number (ISSN)

  • 0269-2813

Digital Object Identifier (DOI)

  • 10.1111/apt.15660


  • eng