肝纤维化与多种心脏代谢疾病危险因素相关：Framingham心脏研

StephenW

Hepatic Fibrosis Associates With Multiple Cardiometabolic Disease Risk Factors: The Framingham Heart Study
Hepatology Feb 6 2021 - Michelle T. Long ,1 Xiaoyu Zhang,2 Hanfei Xu,2 Ching-Ti Liu ,2 Kathleen E. Corey ,3 Raymond T. Chung,3
Rohit Loomba ,4 and Emelia J. Benjamin
Abstract
Background and Aims

NAFLD is increasing in prevalence and will soon be the most common chronic liver disease. Liver stiffness, as assessed by vibration‐controlled transient elastography (VCTE), correlates with hepatic fibrosis, an important predictor of liver‐related and all‐cause mortality. Although liver fat is associated with cardiovascular risk factors, the association between hepatic fibrosis and cardiovascular risk factors is less clear.
Approach and Results

We performed VCTE, assessing controlled attenuation parameter (CAP; measure of steatosis) and liver stiffness measurement (LSM) in 3,276 Framingham Heart Study adult participants (53.9% women, mean age 54.3 ± 9.1 years) presenting for a routine study visit. We performed multivariable‐adjusted logistic regression models to determine the association between LSM and obesity‐related, vascular‐related, glucose‐related, and cholesterol‐related cardiovascular risk factors.

The prevalence of hepatic steatosis (CAP ≥ 290 dB/m) was 28.8%, and 8.8% had hepatic fibrosis (LSM ≥ 8.2 kPa). Hepatic fibrosis was associated with multiple cardiovascular risk factors, including increased odds of obesity (OR, 1.82; 95% CI, 1.35‐2.47), metabolic syndrome (OR, 1.49; 95% CI 1.10‐2.01), diabetes (OR, 2.67; 95% CI, 1.21‐3.75), hypertension (OR, 1.52; 95% CI, 1.15‐1.99), and low high‐density lipoprotein cholesterol (OR, 1.47; 95% CI, 1.09‐1.98), after adjustment for age, sex, smoking status, alcohol drinks/week, physical activity index, aminotransferases, and CAP.
Conclusions

In our community‐based cohort, VCTE‐defined hepatic fibrosis was associated with multiple cardiovascular risk factors, including obesity, metabolic syndrome, diabetes, hypertension, and high‐density lipoprotein cholesterol, even after accounting for covariates and CAP. Additional longitudinal studies are needed to determine if hepatic fibrosis contributes to incident cardiovascular disease risk factors or events.
Multivariable‐Adjusted Associations Between Hepatic Fibrosis and Continuous Cardiometabolic Risk Factors

Hepatic fibrosis (as both a continuous and dichotomous measure) was significantly associated with all obesity‐related, liver‐related, glucose‐related, vascular‐related, and cholesterol‐related continuous cardiometabolic traits (Table 3). Hepatic fibrosis (LSM ≥ 8.2) was associated with higher BMI, higher waist circumference, higher CAP, higher log‐ALT and log‐AST, higher fasting glucose, higher log‐hgbA1c, higher SBP and DBP, higher log‐triglycerides, lower total cholesterol, and lower HDL cholesterol compared with those without hepatic fibrosis. After additionally adjusting for BMI or CAP, most of the associations with hepatic fibrosis were attenuated; however, for total cholesterol, the negative association with hepatic fibrosis was stronger after additionally adjusting for BMI or CAP. Hepatic fibrosis (LSM ≥ 8.2) was no longer associated with DBP or log‐triglycerides in CAP‐adjusted models.     

StephenW

肝纤维化与多种心脏代谢疾病危险因素相关：Framingham心脏研究
肝病学2021年2月6日-米歇尔·T·朗，1肖张宇，2徐汉飞，2刘庆Ti，2凯瑟琳·E·科里，3雷蒙德·钟，3
Rohit Loomba，4和Emelia J. Benjamin
抽象
背景和目标

NAFLD的患病率正在增加，并将很快成为最常见的慢性肝病。通过振动控制的瞬时弹性成像（VCTE）评估的肝硬度与肝纤维化有关，肝纤维化是肝相关和全因死亡率的重要预测指标。尽管肝脂肪与心血管危险因素有关，但肝纤维化与心血管危险因素之间的关系尚不清楚。
方法与结果

我们进行了VCTE，评估了3276名参加常规研究访问的Framingham心脏研究的成年参与者（53.9％的女性，平均年龄54.3±9.1岁）的受控衰减参数（CAP；脂肪变性的测量）和肝硬度测量（LSM）。我们进行了多变量调整的逻辑回归模型，以确定LSM与肥胖相关，血管相关，葡萄糖相关和胆固醇相关的心血管危险因素之间的关联。

肝脂肪变性（CAP≥290 dB / m）的患病率为28.8％，而肝纤维化（LSM≥8.2 kPa）的患病率为8.8％。肝纤维化与多种心血管危险因素有关，包括肥胖几率（OR，1.82; 95％CI，1.35-2.47），代谢综合征（OR，1.49; 95％CI 1.10-2.01），糖尿病（OR，2.67;在调整了年龄之后，95％CI，1.21-3.75），高血压（OR，1.52; 95％CI，1.15-1.99）和低高密度脂蛋白胆固醇（OR，1.47; 95％CI，1.09-1.98），性别，吸烟状况，每周饮酒，身体活动指数，转氨酶和CAP。
结论

在我们基于社区的队列研究中，即使考虑了协变量和CAP，VCTE定义的肝纤维化也与多种心血管危险因素相关，包括肥胖，代谢综合征，糖尿病，高血压和高密度脂蛋白胆固醇。需要进行额外的纵向研究，以确定肝纤维化是否导致心血管疾病的危险因素或事件。
肝纤维化与持续性心脏代谢危险因素之间的多变量调整关联

肝纤维化（连续和二分法）均与所有肥胖相关，肝脏相关，葡萄糖相关，血管相关和胆固醇相关的持续心脏代谢特征显着相关（表3）。肝纤维化（LSM≥8.2）与较高的BMI，较高的腰围，较高的CAP，较高的log-ALT和log-AST，较高的空腹血糖，较高的log-hgbA1c，较高的SBP和DBP，较高的log-甘油三酸酯，较低的总胆固醇相关与没有肝纤维化的患者相比，胆固醇水平和低密度脂蛋白胆固醇水平更低。在另外调整了BMI或CAP之后，大多数与肝纤维化的相关性减弱了。然而，对于总胆固醇，在另外调整BMI或CAP后，与肝纤维化的负相关性更强。在CAP调整模型中，肝纤维化（LSM≥8.2）不再与DBP或对数甘油三酯相关。