A0487 - Risk and Incidence of Cardiovascular Diseases in Patients With Normal Weight and Nonalcoholic Fatty Liver Disease: A Large Population-Based Multicenter Study

Introduction: Nonalcoholic fatty liver disease (NAFLD) is known as a risk of incident cardiovascular disease (CVD). Patients with NAFLD who are overweight or obese are at increased risk for adverse CVD events and diseases. However, it remains to be elucidated the association between normal-weight patients with NAFLD and risk of CVD. We investigated the risk of incident CVD in normal-weight individuals with NAFLD compared to overweight/obese-NAFLD patients at a population level.

Methods: This multicentre, retrospective cohort study was conducted using the TriNetX platform. Adult patients ( >18 years) diagnosed with NAFLD were identified after excluding other chronic liver diseases between March 2008 and April 2022. Patients were stratified by body mass index (BMI) into normal weight (BMI, 18.5-24.9 kg/m2) and overweight/obese (BMI >25 kg/m2). Any patients with a history of CVD events or procedures before March 2008 were excluded. The main outcome was to assess the incidence of major CVD events. We performed a 1:1 propensity score matching (PSM) for demographics, smoking, hypertension, diabetes, hyperlipidemia, and comorbid conditions. We conducted sensitivity analyses by comparing individuals who were normal weight with NAFLD to those who were normal weight without NAFLD. The risk ratio (RR) was calculated to compare the association between weight and the outcome

Results: A total of 5,542,269 patients were analyzed. After PSM, there were 33,245 patients with normal weight or overweight/obesity and NAFLD. Normal weight individuals with NAFLD had a lower risk of CVD such as heart failure(HF), ischemic heart disease(IHD), acute myocardial infarction(AMI), composite MI, cerebrovascular disease, transient ischemic attack, arterial fibrillation (AF), and CVD-related procedures compared to the overweight/obese-NAFLD patients (Table1). However, normal-weight individuals with NAFLD had a higher risk of CVD such as HF (RR 1.25, 95% CI 1.15-1.35), IHD(RR 1.19, 95% CI 1.13-1.26), AMI (RR 1.27,95% CI 1.10-1.46), composite MI (RR 1.26,95% CI 1.10-1.45), peripheral vascular diseases (RR 1.18,95% CI 1.12-1.25), and cerebrovascular disease( RR 1.20, 95% CI 1.12-1.29), compared to the normal-weight individuals without NAFLD.

Discussion: Patients with normal-weight NAFLD are not protected from incident CVD compared to those without NAFLD. However, patients with overweight/obesity and NAFLD appear to be at increased risk for CVD compared to the normal-weight patients.