Severe liver steatosis as potential risk factor of cardiovascular disease in patients with type 2 diabetes: a prospective cohort study

AbstractBackground and Aims: Non-alcoholic fatty liver disease (NAFLD), accelerates the progression of atherosclerosis and development of cardiovascular diseases (CVD) which is the most common cause of mortality in NAFLD patients. Methods and results In this prospective cohort study, 1197 patients with type 2 diabetes (T2D) were divided in to two groups (360 patients with NAFLD and 847 without) and were followed for median of 5 years for incidence of CVD. Cox regression analysis was used to assess the association between NAFLD, level of liver enzymes, and aspartate aminotransferase to platelet ratio index (APRI), and incidence risk of CVD and its subgroups (i.e., Myocardial Infarction, chronic heart disease, coronary artery bypass grafting, and percutaneous coronary intervention. There was a significant positive association between CVD incidence and NAFLD (HR = 1.487, 95% CI = 1.041–2.124, p-value = 0.029). Although patients with NAFLD had higher ALT and AST levels (p-value = < 0.001), there was no significant association between liver enzymes and the incidence risk of CVD when adjusting for different variables. Furthermore, NAFLD was linked to APRI Q (2), APRI Q(3), and APRIQ(4) NAFLD (1.365 (1.046–1.781), 1.623 (1.234–2.135), and 3.373 (2.509–4.536), respectively. Conclusion NAFLD increased the incidence risk of CVD in T2D. However, there was no association between liver enzymes (ALT, AST, ALK-P, and GGT) and a higher incidence risk of CVD in T2D when adjusted for confounding variables.