Coronary Artery Disease and Major Adverse Cardiovascular Events in People With Hepatic Steatosis at Low Atherosclerotic Cardiovascular Disease Risk

Julia Karady; Thomas Mayrhofer; Borek Foldyna; Michael T Lu; Nandini Meyersohn; Udo Hoffmann; Oluwafemi Balogon; Neha Pagidipati; Svati Shah; Pamela S Douglas; Maros Ferencik; Kathleen Corey

doi:10.1111/apt.18415

Coronary Artery Disease and Major Adverse Cardiovascular Events in People With Hepatic Steatosis at Low Atherosclerotic Cardiovascular Disease Risk

Aliment Pharmacol Ther. 2024 Nov 29. doi: 10.1111/apt.18415. Online ahead of print.

Authors

Julia Karady^{1

2}, Thomas Mayrhofer^{1

3}, Borek Foldyna¹, Michael T Lu¹, Nandini Meyersohn¹, Udo Hoffmann^{1

4}, Oluwafemi Balogon⁵, Neha Pagidipati⁶, Svati Shah^{6

7}, Pamela S Douglas⁶, Maros Ferencik⁸, Kathleen Corey⁵

Affiliations

¹ Cardiovascular Imaging Research Center, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts, USA.
² Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
³ School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany.
⁴ Cleerly Inc., Denver, Colorado, USA.
⁵ Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
⁷ Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA.
⁸ Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA.

PMID: 39610294
DOI: 10.1111/apt.18415

Abstract

Background: Hepatic steatosis (HS) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥ 7.5% are associated with increased risk for cardiovascular events.

Aim: To assess underlying coronary artery disease (CAD) and major adverse cardiovascular event (MACE) among those with and without HS at different ASCVD risk.

Methods: We evaluated stable chest pain patients receiving coronary computed tomography (CT) in the PROMISE trial. HS and CAD endpoints were defined on coronary CT. MACE was defined as unstable angina, non-fatal myocardial infarction, and all-cause death. Multivariable Cox regression, adjusting for CAD characteristics, assessed the association of HS with MACE for ASCVD < 7.5%.

Results: One thousand two hundred and four of 3702 (32.5%) patients were at ASCVD < 7.5% and 20.3% (244/1204) of them had HS. Individuals with HS were younger (54.3 ± 5.2 vs. 55.8 ± 5.2; p < 0.001), more often males (40.2% [98/244] vs. 27.1% [260/960]; p < 0.001), had more risk factors/person (2.06 ± 0.89 vs. 1.93 ± 0.91; p = 0.047). CAD characteristics were similar between HS vs. non-HS patients at ASCVD < 7.5% and ASCVD ≥ 7.5% (all p > 0.05). Patients with HS had greater MACE rate compared to non-HS patients (ASCVD < 7.5%: 3.75%[9/244] vs. 1.5% [14/960]; p = 0.027 and ASCVD ≥ 7.5%: 4.7% [33/696] vs. 3.1% [56/1802]; p = 0.043). In patients without HS, MACE rate was higher in the ASCVD ≥ 7.5% vs. < 7.5% (3.1% [56/1802] vs. 1.5% [14/960]; p = 0.011). In patients with HS, MACE rates were not significantly different between ASCVD ≥ 7.5% vs. < 7.5% (4.7% [33/696] vs. 3.7% [9/244]; p = 0.484). In ASCVD < 7.5%, HS predicted MACE (aHR:2.34, 95%CI:1.01-5.43; p = 0.048), independent of CAD characteristics.

Conclusions: Individuals with HS at ASCVD < 7.5% risk had similar CAD characteristics as patients without HS at < 7.5% ASCVD risk, yet experienced comparable MACE rates as those at ASCVD ≥ 7.5%.

Keywords: cardiovascular risk; coronary CT imaging; coronary artery disease; hepatic steatosis; major adverse cardiovascular events.

Abstract

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