P1206 - Association of NAFLD With and Without Advanced Fibrosis With Fatal, Non-Fatal, and Combined Cardiovascular Events: A Systematic Review and Meta-Analysis

Mannat Kaur. Bhatia, MD¹, Junaid Ali, MD¹, Allan Santos, MD¹, Archit Garg, MD², Mehar K Bhatia, MBBS³, Mehak Bassi, MD¹, Roula Sasso, MD⁴, Babu Mohan, MD⁵, Arkady Broder, MD^2
1Saint Peter's University Hospital / Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; ²Saint Peter's University Hospital, New Brunswick, NJ; ³Government Medical College, Ludhiana, Punjab, India; ⁴University of New Mexico Health Sciences Center, Albuquerque, NM; ⁵Orlando Gastroenterology PA, Orlando, FL

Introduction: Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized as a risk factor for cardiovascular disease (CVD). However, the association between NAFLD with and without advanced fibrosis, and the risk of fatal and non-fatal CVD events remains unclear. We conducted a systematic review with meta-analysis to quantify these associations and investigate the impact of the fibrosis stage on CVD risk

Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was conducted up to 2024, following PRISMA guidelines. We included studies conducted in adults > 18 years old, with a confirmed diagnosis of NAFLD either through imaging or histology. Results were reported as pooled hazard ratios (HR) with 95% confidence intervals (CI) for the association of NAFLD, with and without advanced fibrosis, with fatal, non-fatal, or combined CVD events. Random effects meta-analysis was performed using standard methodology and heterogeneity was assessed using the I2% statistics.

Results: Forty-nine studies, encompassing 1,553,770 individuals with NAFLD were included. Mean age was 67.73 years (SD 4.07); median follow-up duration 7.0 years (IQR 7.70). Patient populations were diverse, with varying prevalence of obesity, hypertension, and type 2 diabetes and mean BMI of 24.7. Several studies reported a high prevalence of overweight and obese patients (58%), arterial hypertension (58%), and type 2 diabetes mellitus (26%) in their NAFLD cohorts.



NAFLD without advanced fibrosis was significantly associated with increased risks of fatal (HR 1.46, 95% CI 1.23-1.73, p< 0.01), non-fatal (HR 1.54, 95% CI 1.29-1.84, p< 0.01), and combined CVD events (HR 1.60, 95% CI 1.30-1.97, p< 0.01). In the group with advanced fibrosis, a significant association was observed only for combined CVD events (HR 1.79, 95% CI 1.09-2.92, p< 0.01), while the risks for fatal (HR 1.23, 95% CI 1.00-1.52) and non-fatal CVD events (HR 1.08, 95% CI 0.82-1.42) were not statistically significant.

Discussion: This meta-analysis of 49 studies, encompassing over 1.5 million individuals, confirms that NAFLD, even without advanced fibrosis, is an independent risk factor for CVD. The risk is further amplified with advanced fibrosis, particularly for combined CVD events. The lack of statistical significance for individual fatal and non-fatal events in advanced fibrosis may be due to limited data, emphasizing the need for further research in this subgroup.


Disclosures:


Mannat Kaur. Bhatia, MD¹, Junaid Ali, MD¹, Allan Santos, MD¹, Archit Garg, MD², Mehar K Bhatia, MBBS³, Mehak Bassi, MD¹, Roula Sasso, MD⁴, Babu Mohan, MD⁵, Arkady Broder, MD². P1206 - Association of NAFLD With and Without Advanced Fibrosis With Fatal, Non-Fatal, and Combined Cardiovascular Events: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.