In a recent study published in british medical journalResearchers investigated the association between nonalcoholic fatty liver disease (NAFLD) and all-cause mortality and cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). They found that NAFLD and T2DM patients were at increased risk of cardiovascular disease (CVD) and all-cause mortality.

background

The prevalence of NAFLD is increasing worldwide and is often associated with metabolic disorders accompanied by insulin resistance. This poses serious health concerns, especially as it may lead to liver complications and CVD, which are the leading cause of death in NAFLD patients.

T2DM is a major risk factor for CVD and is closely associated with increased prevalence and severity of NAFLD. The complex relationship between NAFLD and T2DM suggests a synergistic effect on cardiovascular risk, with a significant proportion of T2DM patients suffering from her NAFLD. However, studies examining the association with CVD have yielded mixed results. While some found no correlation, others showed that T2DM patients with NAFLD had twice the risk of CVD compared to those without. Additionally, previous studies were limited by cross-sectional designs and small sample sizes.

To address this gap, researchers in this study used a large population-based longitudinal approach to assess the risk of CVD and all-cause mortality associated with NAFLD in patients with T2DM. I made it my purpose.

About research

This national cohort study utilized data from the National Health Information Database linked to the National Health Examination Program. Exclusion criteria were age <20 years, alcohol intake >30 g/day, missing data, or history of type 1 diabetes, chronic hepatitis B and C, cirrhosis, hepatocellular carcinoma, or CVD. Additionally, patients who developed CVD within 1 year were also excluded.

A total of 7,796,763 participants were selected, and the endpoint was all-cause death, CVD, or occurrence up to December 31, 2018. CVD included myocardial infarction or ischemic stroke, confirmed through hospitalization with corresponding claim by brain magnetic resonance imaging or confirmed by calculation. Tomography. Patients were followed for a median of 8.13 years.

Data regarding anthropometric measurements and laboratory parameters were collected. Blood pressure was measured in a sitting position, and fasting venous blood samples were taken to assess various parameters such as glucose, liver enzymes, lipid profile, and creatinine levels. Additionally, the estimated glomerular filtration rate was determined.

Information on lifestyle factors such as smoking, alcohol intake, regular exercise, and socio-economic status was obtained through a standardized self-assessment questionnaire. Statistical methods included Cox proportional hazards models adjusting for various factors, Kaplan-Meier survival curves, and subgroup analyses.

Results and discussion

Among the participants, 6.49% had T2DM. Grade 1 and 2 NAFLD were found in 22.04% and 11.11% of participants, respectively. T2DM patients had a higher proportion of grade 2 NAFLD (26.73%) and grade 1 NAFLD (34.06%) compared to non-T2DM patients. Among participants with T2DM, 6.77% suffered from CVD, and approximately 8.38% of participants died. In contrast, among those without T2DM, 2.24% had their CVD, and approximately 2.71% of participants died.

CVD, myocardial infarction, ischemic stroke, and all-cause mortality increased with NAFLD severity and were higher in patients with T2DM than in those without. Hazard ratios for these outcomes were also higher for his grade 1 and grade 2 NAFLD compared to no NAFLD, regardless of T2DM status. Furthermore, his 5-year absolute risk of these outcomes increased with NAFLD severity, especially in her T2DM patients. Risk differences for CVD, myocardial infarction, ischemic stroke, and all-cause mortality were higher between no NAFLD and grade 2 NAFLD than between no NAFLD and grade 1 NAFLD. Moreover, these risk differences were higher in T2DM patients compared to non-T2DM patients.

NAFLD was associated with increased risk of cardiovascular disease, myocardial infarction, ischemic stroke, and all-cause mortality in both T2DM and non-T2DM patients (p<0.001). Among patients with NAFLD, patients with grade 2 NAFLD exhibit the highest risk, followed by grade 1 NAFLD.

Furthermore, the incidence of CVD, myocardial infarction, ischemic stroke, and all-cause mortality increases continuously from non-NAFLD to grade 1 NAFLD to grade 2 NAFLD across all age groups, with higher incidence in patients with T2DM. was observed.

Limitations of this study include the use of fatty liver index to define NAFLD, lack of assessment of glycated hemoglobin variability and changes in diabetes medications, and limited generalizability to other ethnicities. This includes the inability to assess liver fibrosis.

conclusion

In conclusion, patients with T2DM, and even patients with mild NAFLD, are at increased risk of cardiovascular disease and all-cause mortality. The risk gap between patients without NAFLD and grade 1 or grade 2 her NAFLD is more pronounced in T2DM patients than in patients without NAFLD. This finding highlights the need for NAFLD screening and prevention in T2DM patients to reduce subsequent cardiovascular risk and mortality.