Page 63 - EASL POSTGRADUATE COURSE
P. 63
Nevertheless, it is recommended to screen for NAFLD in every patient with risk factors for CVD or
established CVD and to screen for CVD in every patient with NAFLD. Patients should be treated
accordingly with life-style modification. This recommendation is debated, as there are no data on cost-
effectiveness and no pharmacological treatment when NAFLD is diagnosed. Metformin is frequently
used, as it seems to have a beneficial effect on CV risk, in patients with insulin resistance although this
is also debated. However, as outlined previously, metformin failed to show beneficial effects on liver
histology. Other metabolic factors should be treated according to the corresponding guidelines.
Table 1. Prospective patient-based cohort studies on the risk of CHD in relation to NAFLD
diagnosed by liver histology. n = number of patients, y = years.
Reference n Mean Histological Comparator Conclusion Remark
follow-up (y) subtypes
Matteoni 132 4 histological All-cause and Increased
et al. (1999) 18.0 Different subtypes within CV mortality liver-related
[5] subtypes the cohort not different mortality
between
subtypes
Dam-Larsen 109 16.7 NAFL General All-cause and
et al. (2004) 420 population CV mortality
[6] 129 7.6 NAFLD not different
Adams 13.7 NAFL/ General Increased CHD 2nd cause
et al. (2005) NASH population all-cause of death
[7] mortality
13.0 NAFL/ NAFL not
Ekstedt NASH Reference Increased significantly
et al. (2006) population liver-related different from
[8] 24.0 NAFL/ and CV reference
NASH mortality in population
NASH
Increased
Rafiq 173 NAFL vs. NASH CHD 1st cause liver-related
et al. (2009) of death in mortality in
[9] both NAFL NASH vs.
and NASH NAFL
Söderberg 118 NAFL vs. NASH Increased No difference
et al. (2010) vs. general CV mortality between NAFL
[10] population in NASH and general
compared population
to NAFL
and general
population
Conclusion
The role of NAFLD in the pathophysiology of CV abnormalities, and hence its independent contribution
to an increased risk of CV morbidity and mortality, is increasingly supported with evidence from animal
models and clinical data. Whether NAFL is still to be considered benign in this regard and whether the
risk is hence confined to NASH, is currently unclear, but the risk seems at least to be more pronounced
in NASH patients compared to NAFL. As the role of NAFLD in CVD becomes clearer, this aspect
of NAFLD should probably be incorporated in the future guidelines on its treatment indications and
paradigms.
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 63
established CVD and to screen for CVD in every patient with NAFLD. Patients should be treated
accordingly with life-style modification. This recommendation is debated, as there are no data on cost-
effectiveness and no pharmacological treatment when NAFLD is diagnosed. Metformin is frequently
used, as it seems to have a beneficial effect on CV risk, in patients with insulin resistance although this
is also debated. However, as outlined previously, metformin failed to show beneficial effects on liver
histology. Other metabolic factors should be treated according to the corresponding guidelines.
Table 1. Prospective patient-based cohort studies on the risk of CHD in relation to NAFLD
diagnosed by liver histology. n = number of patients, y = years.
Reference n Mean Histological Comparator Conclusion Remark
follow-up (y) subtypes
Matteoni 132 4 histological All-cause and Increased
et al. (1999) 18.0 Different subtypes within CV mortality liver-related
[5] subtypes the cohort not different mortality
between
subtypes
Dam-Larsen 109 16.7 NAFL General All-cause and
et al. (2004) 420 population CV mortality
[6] 129 7.6 NAFLD not different
Adams 13.7 NAFL/ General Increased CHD 2nd cause
et al. (2005) NASH population all-cause of death
[7] mortality
13.0 NAFL/ NAFL not
Ekstedt NASH Reference Increased significantly
et al. (2006) population liver-related different from
[8] 24.0 NAFL/ and CV reference
NASH mortality in population
NASH
Increased
Rafiq 173 NAFL vs. NASH CHD 1st cause liver-related
et al. (2009) of death in mortality in
[9] both NAFL NASH vs.
and NASH NAFL
Söderberg 118 NAFL vs. NASH Increased No difference
et al. (2010) vs. general CV mortality between NAFL
[10] population in NASH and general
compared population
to NAFL
and general
population
Conclusion
The role of NAFLD in the pathophysiology of CV abnormalities, and hence its independent contribution
to an increased risk of CV morbidity and mortality, is increasingly supported with evidence from animal
models and clinical data. Whether NAFL is still to be considered benign in this regard and whether the
risk is hence confined to NASH, is currently unclear, but the risk seems at least to be more pronounced
in NASH patients compared to NAFL. As the role of NAFLD in CVD becomes clearer, this aspect
of NAFLD should probably be incorporated in the future guidelines on its treatment indications and
paradigms.
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 63
