Han, Eugene MD, PhD1; Lee, Yong-ho MD, PhD2,3,*; Kim, Young Dae MD, PhD4,*; Kim, Beom Kyung MD, PhD2,5,6; Park, Jun Yong MD, PhD2,5,6; Kim, Do Young MD, PhD2,5,6; Ahn, Sang Hoon MD, PhD2,5,6; Lee, Byung-Wan MD, PhD2,3; Kang, Eun Seok MD, PhD2,3; Cha, Bong-Soo MD, PhD2,3; Han, Kwang-Hyub MD2,5,6; Nam, Hyo Suk MD, PhD4; Heo, Ji Hoe MD, PhD4; Kim, Seung Up MD, PhD2,5,6,*
1Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea;
2Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea;
3Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea;
4Department of Neurology, Yonsei University College of Medicine, Seoul, Korea;
5Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea;
6Yonsei Liver Center, Severance Hospital, Seoul, Korea.
Nonalcoholic fatty liver disease (NAFLD) and sarcopenia have a close association with an increased risk of atherosclerotic cardiovascular disease (ASCVD). This study investigated the influence of NAFLD and sarcopenia on ASCVD risk.
Data from the 2008–2011 Korean National Health and Nutrition Examination Surveys database were analyzed (n = 7,191). The sarcopenia index was calculated using dual-energy x-ray absorptiometry. Sarcopenia was defined as the lowest quintile sarcopenia index value (cutoffs = 0.882 for men and 0.582 for women). NAFLD was defined as a comprehensive NAFLD score ≥40. Liver fibrosis was assessed using the fibrosis-4 (FIB-4) index. ASCVD risk was evaluated using American College of Cardiology/American Heart Association guidelines. High probability of ASCVD was defined as ASCVD risk >10%.
The prevalence rates of NAFLD and sarcopenia were 31.2% (n = 2,241) and 19.5% (n = 1,400), respectively. The quartile-stratified ASCVD risk scores were positively associated with NAFLD and sarcopenia (all P for trend < 0.001). Subjects with both NAFLD and sarcopenia had a higher risk for high probability of ASCVD (odds ratio = 1.83, P = 0.014) compared with controls without NAFLD and sarcopenia. Among subjects with NAFLD, FIB-4–defined significant liver fibrosis and sarcopenia additively raised the risk for high probability of ASCVD (odds ratio = 3.56, P < 0.001) compared with controls without FIB-4–defined significant liver fibrosis or sarcopenia.
NAFLD and sarcopenia were significantly associated with an increased risk of ASCVD in the general population. In addition, NAFLD with significant liver fibrosis and sarcopenia were significantly associated with an increased risk of ASCVD in subjects with NAFLD.