Nonalcoholic Fatty Liver Disease Increases Cardiovascular Risk in Inflammatory Bowel Diseases

Dana Kablawi; Faisal Aljohani; Chiara Saroli Palumbo; Sophie Restellini; Alain Bitton; Gary Wild; Waqqas Afif; Peter L Lakatos; Talat Bessissow; Giada Sebastiani

doi:10.1093/crocol/otad004

Nonalcoholic Fatty Liver Disease Increases Cardiovascular Risk in Inflammatory Bowel Diseases

Crohns Colitis 360. 2023 Feb 2;5(1):otad004. doi: 10.1093/crocol/otad004. eCollection 2023 Jan.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada.
² Division of Gastroenterology, Jewish General Hospital, Montreal, Quebec, Canada.
³ Gastroenterology Department, University Hospital of Geneva, Geneva, Switzerland.
⁴ 1st Department of Medicine, Semmelweis University, Budapest, Hungary.

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. Both conditions seem more frequent in patients with inflammatory bowel disease (IBD). We aimed to assess the effect of NAFLD and liver fibrosis on intermediate-high cardiovascular risk in IBD.

Methods: We prospectively included IBD patients undergoing a routine screening program for NAFLD by transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD and significant liver fibrosis were defined as CAP ≥275 dB m^-1 and liver stiffness measurement by TE ≥8 kPa, respectively. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator and categorized as low if <5%, borderline if 5%-7.4%, intermediate if 7.5%-19.9%, and high if ≥20% or if previous cardiovascular event. Predictors of intermediate-high cardiovascular risk were investigated by multivariable logistic regression analysis.

Results: Of 405 patients with IBD included, 278 (68.6%), 23 (5.7%), 47 (11.6%), and 57 (14.1%) were categorized as at low, borderline, intermediate, and high ASCVD risk, respectively. NAFLD and significant liver fibrosis were found in 129 (31.9%) and 35 (8.6%) patients, respectively. After adjusting for disease activity, significant liver fibrosis and body mass index, predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.97, 95% CI, 1.56-5.68), IBD duration (aOR 1.55 per 10 years, 95% CI, 1.22-1.97), and ulcerative colitis (aOR 2.32, 95% CI, 1.35-3.98).

Conclusions: Assessment of cardiovascular risk should be targeted in IBD patients with NAFLD, particularly if they have longer IBD duration and ulcerative colitis.

Keywords: IBD duration; atherosclerotic cardiovascular disease risk; controlled attenuation parameter; transient elastography; ulcerative colitis.