Systematic review and meta‐analysis: Association between liver fibrosis and subclinical atherosclerosis in nonalcoholic fatty liver disease
Mohamad Jamalinia, Fatemeh Zare, Kamran B. Lankarani- Pharmacology (medical)
- Gastroenterology
- Hepatology
Summary
Background
Nonalcoholic fatty liver disease (NAFLD) is a liver disorder commonly associated with metabolic syndrome and cardiovascular disease (CVD). Atherosclerosis, a leading cause of CVD, has been linked to liver fibrosis. However, the evidence regarding this association is conflicting.
Aim
To evaluate the link between liver fibrosis and subclinical atherosclerosis in patients with NAFLD
Methods
We conducted a comprehensive search of four databases from 1950 to February 2023 to identify eligible studies investigating the association between liver fibrosis and subclinical atherosclerosis among patients with NAFLD, utilising the PICOS framework. Two independent reviewers screened the studies; quality was assessed using the Newcastle‐Ottawa Scale. Meta‐analysis was performed using the DerSimonian‐Liard random‐effects model, and subgroup analysis was conducted based on the severity of liver fibrosis, type of subclinical atherosclerosis diagnosis and geographic region.
Results
The meta‐analysis included 12 studies with a total of 4725 patients. Overall pooled odds ratio (OR) for subclinical atherosclerosis was 2.18 (95% CI: 1.62–2.93), indicating a significant association with liver fibrosis in NAFLD. Subgroup analysis revealed higher ORs in patients with more severe fibrosis: 1.64 (95% CI: 1.22–2.20) in ≥F1, 2.22 (95% CI: 1.37–3.62) in ≥F2, and 3.42 (95% CI: 1.81–6.46) in ≥F3. However, there was no significant difference between the West versus East and various measurements of subclinical atherosclerosis.
Conclusions
Any degree of fibrosis is significantly associated with subclinical atherosclerosis, with fibrosis severity amplifying the association.