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