Cardiovascular Diabetology (Aug 2023)

Hepatic steatosis with significant fibrosis is associated with an increased 10-year estimated risk of cardiovascular disease in adults with type 1 diabetes mellitus

  • Alessandro Mantovani,
  • Mario Luca Morieri,
  • Luisa Palmisano,
  • Maria Masulli,
  • Efisio Cossu,
  • Marco Giorgio Baroni,
  • Katia Bonomo,
  • Flavia Agata Cimini,
  • Gisella Cavallo,
  • Raffaella Buzzetti,
  • Carmen Mignogna,
  • Frida Leonetti,
  • Simonetta Bacci,
  • Roberto Trevisan,
  • Riccardo Maria Pollis,
  • Raffaella Aldigeri,
  • Alessandra Dei Cas,
  • Saula Vigili de Kreutzenberg,
  • Giovanni Targher

DOI
https://doi.org/10.1186/s12933-023-01945-x
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 12

Abstract

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Abstract Background We assessed whether hepatic steatosis with or without significant fibrosis (determined by validated non-invasive biomarkers) is associated with an increased 10-year estimated risk for cardiovascular disease (CVD) in people with type 1 diabetes mellitus (T1DM). Methods We conducted a retrospective, multicenter, cross-sectional study involving 1,254 adults with established T1DM without pre-existing CVD. We used the hepatic steatosis index (HSI) and fibrosis (FIB)-4 index for non-invasively detecting hepatic steatosis (defined as HSI > 36), with or without coexisting significant fibrosis (defined as FIB-4 index ≥ 1.3 or < 1.3). We calculated the Steno type 1 risk engine and the atherosclerotic CVD (ASCVD) risk score to estimate the 10-year risk of developing a first fatal or nonfatal CVD event. Results Using the Steno type 1 risk engine, a significantly greater proportion of patients with hepatic steatosis and significant fibrosis (n = 91) had a high 10-year estimated CVD risk compared to those with hepatic steatosis alone (n = 509) or without steatosis (n = 654) (75.8% vs. 23.2% vs. 24.9%, p < 0.001). After adjustment for sex, BMI, diabetes duration, hemoglobin A1c, chronic kidney disease, and lipid-lowering medication use, patients with hepatic steatosis and significant fibrosis had an increased 10-year estimated risk of developing a first fatal or nonfatal CVD event (adjusted-odds ratio 11.4, 95% confidence interval 3.54–36.9) than those without steatosis. We observed almost identical results using the ASCVD risk calculator. Conclusions The 10-year estimated CVD risk is remarkably greater in T1DM adults with hepatic steatosis and significant fibrosis than in their counterparts with hepatic steatosis alone or without steatosis.

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