OBJECTIVES:

In nonalcoholic steatohepatitis (NASH), the extent of fibrosis is reported to be associated with risk of progression to liver-related morbidity and mortality. In addition, cardiovascular disease (CVD) is recognized to be a leading cause of mortality in patients with NASH. This analysis estimated the risk of a primary cardiovascular (CV) event associated with NASH and the variation in risk across fibrosis stages.

METHODS:

A cross-sectional analysis was conducted using the 2017-March 2020 National Health and Nutrition Examination Survey (NHANES) cycle. Participants with presumed NASH were identified as those with steatosis (controlled attenuation parameter ≥302 dB/m), without other causes of liver disease (hepatitis B/C, excess alcohol consumption), and with FibroScan+AST (FAST) score ≥0.48, using liver-stiffness and steatosis measurements via vibration-controlled transient elastography. The 10-year probability of a primary CV event was estimated by applying the Framingham Heart Study 2008 risk equations for a first coronary heart disease event, cerebrovascular event, peripheral artery disease, or heart failure, among participants without history of CVD. Probabilities were summarized and compared with/without presumed NASH and by fibrosis stage (liver-stiffness measurement [kPa] of <8.2 for F0-F1, 8.2-13.5 for F2-F3, and ≥13.6 for F4).

RESULTS:

Among NHANES participants with complete data for the analysis and aged 30-74 years, N=122 and N=4,139 were included with/without presumed NASH. The weighted proportion (unweighted count) across fibrosis stages F0-F1, F2-F3, and F4 was 26% (30), 36% (43), and 38% (49), respectively. Mean (SE) 10-year probability of a primary CV event was 9.3% (0.20%) without NASH versus 12.0% (1.04%) with NASH (p=0.01). The probability increased at higher fibrosis stages of presumed NASH, from 8.9% (1.32%) in F0-F1 to 13.1% (1.31%) in F2-F4.

CONCLUSIONS:

Predicted primary CV event risk was estimated to be statistically significantly higher among US adults with versus without presumed NASH. Furthermore, the risk increased at higher fibrosis stages.