Clin Mol Hepatol.
2022 Jul;28(3):483-496. 10.3350/cmh.2021.0406.
Non-alcoholic fatty liver disease increases risk of carotid atherosclerosis and ischemic stroke: An updated meta-analysis with 135,602 individuals
- Tang ASP1
- Chan KE1
- Quek J1
- Xiao J1
- Tay P1
- Teng M2
- Lee KS3
- Lin SY1
- Myint MZ4
- Tan B4
- Sharma VK4
- Tan DJH1
- Lim WH1
- Kaewdech A5
- Huang D1,2,6
- Chew NW1,7
- Siddiqui MS8
- Sanyal AJ8
- Muthiah M
2,6 - Ng CH1
- Affiliations
-
- 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- 2Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- 3Bristol Medical School, University of Bristol, Bristol, UK
- 4Division of Neurology, Department of Medicine, National University Hospital, Singapore
- 5Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- 6National University Centre for Organ Transplantation, National University Health System, Singapore
- 7Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
- 8Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
- KMID: 2531373
- DOI: http://doi.org/10.3350/cmh.2021.0406
Abstract
- Background/Aims
Non-alcoholic fatty liver disease (NAFLD) is associated with the development of cardiovascular disease. While existing studies have examined cardiac remodeling in NAFLD, there has been less emphasis on the development of carotid atherosclerosis and stroke. We sought to conduct a meta-analysis to quantify the prevalence, risk factors, and degree of risk increment of carotid atherosclerosis and stroke in NAFLD.
Methods
Embase and Medline were searched for articles relating to NAFLD, carotid atherosclerosis, and stroke. Proportional data was analysed using a generalized linear mixed model. Pairwise meta-analysis was conducted to obtain odds ratio or weighted mean difference for comparison between patients with and without NAFLD.
Results
From pooled analysis of 30 studies involving 7,951 patients with NAFLD, 35.02% (95% confidence interval [CI], 27.36–43.53%) had carotid atherosclerosis with an odds ratio of 3.20 (95% CI, 2.37–4.32; P<0.0001). Pooled analysis of 25,839 patients with NAFLD found the prevalence of stroke to be 5.04% (95% CI, 2.74–9.09%) with an odds ratio of 1.88 (95% CI, 1.23–2.88; P=0.02) compared to non-NAFLD. The degree of steatosis assessed by ultrasonography in NAFLD was closely associated with risk of carotid atherosclerosis and stroke. Older age significantly increased the risk of developing carotid atherosclerosis, but not stroke in NAFLD.
Conclusions
This meta-analysis shows that a stepwise increment of steatosis of NAFLD can significantly increase the risk of carotid atherosclerosis and stroke development in NAFLD. Patients more than a third sufferred from carotid atherosclerosis and routine assessment of carotid atherosclerosis is quintessential in NAFLD.
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