Clinical and Molecular Hepatology (Jul 2022)

Non-alcoholic fatty liver disease increases risk of carotid atherosclerosis and ischemic stroke: An updated meta-analysis with 135,602 individuals

  • Ansel Shao Pin Tang,
  • Kai En Chan,
  • Jingxuan Quek,
  • Jieling Xiao,
  • Phoebe Tay,
  • Margaret Teng,
  • Keng Siang Lee,
  • Snow Yunni Lin,
  • May Zin Myint,
  • Benjamin Tan,
  • Vijay K Sharma,
  • Darren Jun Hao Tan,
  • Wen Hui Lim,
  • Apichat Kaewdech,
  • Daniel Huang,
  • Nicholas WS Chew,
  • Mohammad Shadab Siddiqui,
  • Arun J Sanyal,
  • Mark Muthiah,
  • Cheng Han Ng

DOI
https://doi.org/10.3350/cmh.2021.0406
Journal volume & issue
Vol. 28, no. 3
pp. 483 – 496

Abstract

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Background/Aims Non-alcoholic fatty liver disease (NAFLD) is associated with the development of cardiovascular disease. While existing studies have examined cardiac remodeling in NAFLD, there has been less emphasis on the development of carotid atherosclerosis and stroke. We sought to conduct a meta-analysis to quantify the prevalence, risk factors, and degree of risk increment of carotid atherosclerosis and stroke in NAFLD. Methods Embase and Medline were searched for articles relating to NAFLD, carotid atherosclerosis, and stroke. Proportional data was analysed using a generalized linear mixed model. Pairwise meta-analysis was conducted to obtain odds ratio or weighted mean difference for comparison between patients with and without NAFLD. Results From pooled analysis of 30 studies involving 7,951 patients with NAFLD, 35.02% (95% confidence interval [CI], 27.36–43.53%) had carotid atherosclerosis with an odds ratio of 3.20 (95% CI, 2.37–4.32; P<0.0001). Pooled analysis of 25,839 patients with NAFLD found the prevalence of stroke to be 5.04% (95% CI, 2.74–9.09%) with an odds ratio of 1.88 (95% CI, 1.23–2.88; P=0.02) compared to non-NAFLD. The degree of steatosis assessed by ultrasonography in NAFLD was closely associated with risk of carotid atherosclerosis and stroke. Older age significantly increased the risk of developing carotid atherosclerosis, but not stroke in NAFLD. Conclusions This meta-analysis shows that a stepwise increment of steatosis of NAFLD can significantly increase the risk of carotid atherosclerosis and stroke development in NAFLD. Patients more than a third sufferred from carotid atherosclerosis and routine assessment of carotid atherosclerosis is quintessential in NAFLD.

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