TY - JOUR
T1 - Association between nonalcoholic fatty liver disease with advanced fibrosis and stroke
AU - Parikh, Neal S.
AU - VanWagner, Lisa B.
AU - Elkind, Mitchell S.V.
AU - Gutierrez, Jose
N1 - Funding Information:
This study was supported by National Institute of Neurological Disorders and Stroke grant T32NS07153 (PI: Elkind, Trainee: Parikh), and National Heart, Lung, and Blood Institute grant K23HL136891 (VanWagner). The funding sources had no involvement in study design, analysis and interpretation of data, writing of the manuscript, or in the decision to submit the article for publication.
Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2019/12/15
Y1 - 2019/12/15
N2 - Background: There is an increasing appreciation of the cardiovascular implications of nonalcoholic fatty liver disease with advanced fibrosis (NAFLD-fibrosis). However, data regarding stroke risk are limited. We sought to investigate whether NAFLD-fibrosis is associated with stroke in addition to heart disease. Methods: We performed a cross-sectional study using data from the United States National Health and Nutrition Examination Survey (2005–2014). After excluding participants with competing causes of liver disease, the Fibrosis-4 score (FIB-4) and NAFLD Fibrosis Score (NFS) were calculated. First, we used a composite measure to classify participants: NAFLD-fibrosis was defined as having at least one score above its validated cut-off. Second, we also used the FIB-4 and NFS scores individually. The key outcome was prevalent stroke, and we also evaluated heart disease; both were self-reported. Multivariable logistic regression assessed the association between NAFLD-fibrosis and these outcomes while adjusting for demographic variables and cardiovascular risk factors. Results: We identified 1653 participants with NAFLD-fibrosis from a sample of 27,040 participants. In total, 753 had prior stroke. An association between NAFLD-fibrosis and stroke was seen when using the FIB-4 score (OR 1.87, 95% CI 1.00–3.50) but not the NFS (OR 1.31, 95% CI 0.92–1.87). NAFLD-fibrosis was associated with heart disease (OR 1.46, 95% CI 1.06–2.01) using the composite measure and both scores individually. Conclusions: NAFLD-fibrosis may be associated with stroke in addition to heart disease, with differences depending on the measure used to define NAFLD-fibrosis.
AB - Background: There is an increasing appreciation of the cardiovascular implications of nonalcoholic fatty liver disease with advanced fibrosis (NAFLD-fibrosis). However, data regarding stroke risk are limited. We sought to investigate whether NAFLD-fibrosis is associated with stroke in addition to heart disease. Methods: We performed a cross-sectional study using data from the United States National Health and Nutrition Examination Survey (2005–2014). After excluding participants with competing causes of liver disease, the Fibrosis-4 score (FIB-4) and NAFLD Fibrosis Score (NFS) were calculated. First, we used a composite measure to classify participants: NAFLD-fibrosis was defined as having at least one score above its validated cut-off. Second, we also used the FIB-4 and NFS scores individually. The key outcome was prevalent stroke, and we also evaluated heart disease; both were self-reported. Multivariable logistic regression assessed the association between NAFLD-fibrosis and these outcomes while adjusting for demographic variables and cardiovascular risk factors. Results: We identified 1653 participants with NAFLD-fibrosis from a sample of 27,040 participants. In total, 753 had prior stroke. An association between NAFLD-fibrosis and stroke was seen when using the FIB-4 score (OR 1.87, 95% CI 1.00–3.50) but not the NFS (OR 1.31, 95% CI 0.92–1.87). NAFLD-fibrosis was associated with heart disease (OR 1.46, 95% CI 1.06–2.01) using the composite measure and both scores individually. Conclusions: NAFLD-fibrosis may be associated with stroke in addition to heart disease, with differences depending on the measure used to define NAFLD-fibrosis.
KW - Cerebrovascular disease
KW - Epidemiology
KW - Liver disease
KW - Risk factors
KW - Stroke
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U2 - 10.1016/j.jns.2019.116524
DO - 10.1016/j.jns.2019.116524
M3 - Article
C2 - 31644993
AN - SCOPUS:85073478710
SN - 0022-510X
VL - 407
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
M1 - 116524
ER -