Impact of Non-Alcoholic Fatty Liver Disease Severity on Coronary Artery Disease Progression: A Retrospective Cohort Study

Additional Authors

Nasir Notta, Department of Internal Medicine, University of Tennessee, Knoxville, TN Ashwin Jagadish, Department of Internal Medicine, East Tennessee State University, Johnson City, TN Vijay Ramu, Department of Cardiology, East Tennessee State University, Johnson City, TN

Abstract

Introduction Non-alcoholic fatty liver disease (NAFLD) is a known cardiometabolic risk factor, yet its impact on coronary artery disease (CAD) progression remains uncertain. Hepatic fibrosis in NAFLD may contribute to accelerated atherosclerosis via systemic inflammation, insulin resistance, and endothelial dysfunction. This study evaluates the association between NAFLD severity and CAD progression, focusing on liver fibrosis as a potential predictor of cardiovascular risk. Methods A retrospective cohort study was conducted from the Nationwide Inpatient Sample database on patients with NAFLD and CAD who underwent serial coronary imaging (angiography or coronary calcium scoring) between 2015–2023. NAFLD severity was categorized using the Fibrosis-4 Index (Fib-4): mild (<1.3), moderate (1.3–2.67), and severe (>2.67). Primary outcomes included CAD progression (≥20% stenosis increase or new obstructive lesion >70%) and major adverse cardiac events (MACE: myocardial infarction, stroke, or cardiovascular death). Statistical analysis included multivariate logistic regression adjusted for age, diabetes, hypertension, dyslipidemia, BMI, and statin use. Results A total of 1,275 patients (mean age 62.4 ± 9.8 years, 54.2% male) were analyzed. CAD progression was observed in 15.2% of mild, 29.7% of moderate, and 48.4% of severe NAFLD patients (p<0.001). After adjustment for confounders, severe NAFLD was associated with a 2.6-fold higher risk of CAD progression (OR 2.61, 95% CI 1.89–3.45, p<0.001). MACE incidence was highest in the severe NAFLD group (21.5%) compared to moderate (12.3%) and mild (5.7%) (p=0.003). Fib-4 >2.67 and liver stiffness >10 kPa were independent predictors of CAD progression and MACE. Conclusion NAFLD severity, particularly advanced fibrosis, is strongly associated with CAD progression and increased cardiovascular events. These findings highlight the need for incorporating liver fibrosis assessment into cardiovascular risk stratification models to improve early intervention and patient outcomes.

Start Time

16-4-2025 1:30 PM

End Time

16-4-2025 4:00 PM

Presentation Type

Poster

Presentation Category

Science, Technology and Engineering

Student Type

Clinical Resident or Fellow

Faculty Mentor

Manar Jbara

Faculty Department

Cardiology

This document is currently not available here.

Share

COinS
 
Apr 16th, 1:30 PM Apr 16th, 4:00 PM

Impact of Non-Alcoholic Fatty Liver Disease Severity on Coronary Artery Disease Progression: A Retrospective Cohort Study

Introduction Non-alcoholic fatty liver disease (NAFLD) is a known cardiometabolic risk factor, yet its impact on coronary artery disease (CAD) progression remains uncertain. Hepatic fibrosis in NAFLD may contribute to accelerated atherosclerosis via systemic inflammation, insulin resistance, and endothelial dysfunction. This study evaluates the association between NAFLD severity and CAD progression, focusing on liver fibrosis as a potential predictor of cardiovascular risk. Methods A retrospective cohort study was conducted from the Nationwide Inpatient Sample database on patients with NAFLD and CAD who underwent serial coronary imaging (angiography or coronary calcium scoring) between 2015–2023. NAFLD severity was categorized using the Fibrosis-4 Index (Fib-4): mild (<1.3), moderate (1.3–2.67), and severe (>2.67). Primary outcomes included CAD progression (≥20% stenosis increase or new obstructive lesion >70%) and major adverse cardiac events (MACE: myocardial infarction, stroke, or cardiovascular death). Statistical analysis included multivariate logistic regression adjusted for age, diabetes, hypertension, dyslipidemia, BMI, and statin use. Results A total of 1,275 patients (mean age 62.4 ± 9.8 years, 54.2% male) were analyzed. CAD progression was observed in 15.2% of mild, 29.7% of moderate, and 48.4% of severe NAFLD patients (p<0.001). After adjustment for confounders, severe NAFLD was associated with a 2.6-fold higher risk of CAD progression (OR 2.61, 95% CI 1.89–3.45, p<0.001). MACE incidence was highest in the severe NAFLD group (21.5%) compared to moderate (12.3%) and mild (5.7%) (p=0.003). Fib-4 >2.67 and liver stiffness >10 kPa were independent predictors of CAD progression and MACE. Conclusion NAFLD severity, particularly advanced fibrosis, is strongly associated with CAD progression and increased cardiovascular events. These findings highlight the need for incorporating liver fibrosis assessment into cardiovascular risk stratification models to improve early intervention and patient outcomes.