NAFLD FIBROSIS SCORE IS ASSOCIATED WITH CARDIOVASCULAR DISEASE IN PATIENTS UNDERGOING CORONAROGRAPHY

Background and Aims: A strong association has been evidenced between non-alcoholic-fatty-liver-disease (NAFLD) and cardiovascular disease (CVD). In studies including liver biopsy, diagnosis of non-alcoholic-steatohepatitis and, mainly, advanced fibrosis were independent predictors of poor cardiovascular outcomes. However, liver biopsy is an invasive procedure not suitable on a large scale. We aimed to verify the association of NAFLD fibrosis score (NFS), a validated non-invasive predictor of liver fibrosis in NAFLD patients, and different cardiovascular outcomes in a population of patients candidate to coronarography for clinical purposes. Patients and Methods: Two-hundred-thirteen patients were studied. Each patient underwent coronarography with evaluation of coronary plaques and carotid Doppler ultrasound for estimation of intima-media-thickness (IMT) and of carotid plaques, and 81 patients received liver trasound for assessment of steatosis. NFS results were stratified in 3 groups according to the criteria suggested: 0, no significant fibrosis; 1, indeterminate; 2, significant fibrosis. Results: In the 67 patients with steatosis on the 81 undergoing liver ultrasound, NFS showed significant correlations with IMT (ø = 0.41, p = 0.001) and carotid plaques (ø = 0.37, p = 0.003), but not with coronary plaques (ø = 0.11, p = 0.386). In the remaining 132 patients not pre-screened by ultrasound, NFS correlated with IMT (ø = 0.34, p < 0.001), carotid plaques (ø = 0.37, p < 0.001), and coronary plaques (ø = 0.25, p < 0.001). In the whole sample, patients with score 1 or 2 NFS showed a higher risk of increased IMT [OR 2.5 (1.5–4.1)], carotid plaques [OR 3.7 (2.2–6.3)], and coronary plaques [OR 2.2 (1.4–3.5)], with respect to patients with score 0. Score 2 NFS was not associated with an increased risk compared to score 1. Even in this population with high pre-test probability of CVD, absence of significant fibrosis by NFS shows reasonable negative predictive values for increased IMT, presence of carotid and of coronary plaques, (70%, 74% and 73%, respectively). Conclusions: In this population of candidates to coronarography, NFS is associated with poor cardiovascular outcomes and the association is maintained even not pre-screening for steatosis. These results, which need to be confirmed in other populations of patients, reinforce the hypothesis that similar determinants contribute to progression of liver fibrosis and CVD.