OBJECTIVES: The aims of this study were to (1) examine changes in triglycerides, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol after a diagnosis of nonalcoholic steatohepatitis (NASH), and (2) measure the incidence of liver cirrhosis (LC) and hepatocellular cancer (HCC) by lipid type.

METHODS: Patients with a laboratory measure for triglycerides, LDL-, or HDL-cholesterol in the year prior to their first diagnosis of NASH (ICD-10 code K75.81; defined as baseline period) were identified in a large electronic medical record network. Mean values for each lipid were assessed in the 1^st, 2^nd, and 3^rd year after the first NASH diagnosis. LC and HCC incidence were measured in patients with consistently abnormal and normal baseline values. Risk ratios (95% CIs) compared triglyceride (150+ vs <150 mg/dL), HDL (<60 vs 60+ mg/dL), and LDL (130+ vs <130 mg/dL)] values, adjusting for confounding using a 1:1 matched greedy-nearest-neighbor propensity score model.

RESULTS: Patients were 57±13 years old and 45% male at baseline (triglycerides: N=12,070; LDL: N=12,042; and HDL: N=13,124). After the incident diagnosis of NASH, the mean triglyceride values increased monotonically (baseline:176 mg/dL; 3^rd year: 185 mg/dL), LDL values decreased monotonically (baseline: 96.8 mg/dL; 3^rd year: 90 mg/dL), and HDL values remained stable. After adjusting for co-morbidities and baseline medications, patients with abnormal triglycerides were 1.6 (1.1-2.4) times as likely to develop LC. Patients with abnormal HDL, were 1.6 (0.7-3.3) times as likely to develop HCC. Other models did not predict progression.

CONCLUSIONS: Mean triglyceride values increased in the 3-years following the incident NASH diagnosis and elevated triglycerides at baseline predicted progression to LC. Although not statistically significant, patients with abnormal HDL had an increased risk of HCC. Robust laboratory data provides real-world-evidence to support studies showing triglyceride values to be an important bio-marker for disease progression and interventions in NASH patients.