Steatosis is significantly associated with the risk for major adverse cardiovascular events (MACE), including death, myocardial infarction, or unstable angina, according to new data from the PROMISE trial.¹

Cardiovascular disease (CVD) accounts for approximately 25% of deaths among patients with nonalcoholic liver disease (NAFLD). However, it is unclear whether NAFLD is an independent risk factor for CVD or whether concurrent metabolic disease leads to CVD.

To explore this relationship, researchers conducted the PROMISE trial,² which examined whether evaluating for CVD using computed tomography (CT) angiography was superior to using traditional functional testing and whether it would affect the incidence of future MACE.

About 10,000 patients were randomly assigned to receive CT angiography imaging (n=4966) or functional testing (n=5007). Of those who underwent CT angiography, 3756 patients also received liver/spleen imaging. The results of the liver/spleen imaging showed that 959 (25.5%) patients had steatosis and 2797 (74.5%) had normal liver function.

After a median follow-up of 25.5 months, the researchers found that the overall rate of major adverse cardiovascular events was 3.1% and that patients with steatosis at baseline had significantly higher rates of MACE than patients without steatosis (4.4% vs 2.6%, respectively).

Steatosis presence at baseline was also associated with a higher prevalence of obesity, metabolic syndrome, type 2 diabetes mellitus, and cardiovascular risk (as defined by ASCVD risk score).

Atherosclerotic burden, defined by CT angiography, was not significantly different between patients with steatosis and those without steatosis at baseline. Similarly, there was no difference in high-risk plaques or calcified or noncalcified plaques, regardless of steatosis status.

“Baseline hepatic steatosis was associated with a 70% increased risk of [MACE],” lead researcher Kathleen E. Corey, MD, concluded.¹ “This risk was independent of traditional cardiovascular risk factors and presence/extent of CAD, including obstructive CAD and measure of plaque burden. Radiographic NAFLD is associated with an increased risk of MACE.”

—Amanda Balbi

References:

1. Corey KE. CVD and NAFLD. Talk presented at: 21st Annual Harvard Nutrition and Obesity Symposium: Nonalcoholic Fatty Liver Disease (NAFLD): Mechanisms and Novel Therapeutics; June 30, 2020; Virtual. Accessed July 1, 2020.
2. PROspective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE). ClinicalTrials.gov. Published August 3, 2010. Updated February 29, 2016. Accessed July 1, 2020. NCT01174550. https://clinicaltrials.gov/ct2/show/NCT01174550