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Letter
The Authors' reply
  1. Maria Stepanova1,2,
  2. Zobair M Younossi1,2
  1. 1Center for Liver Diseases at Inova Fairfax Hospital, Falls Church, Virginia, USA
  2. 2Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
  1. Correspondence to Zobair M Younossi, Center for Liver Diseases at Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA; zobair.younossi{at}inova.org

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We appreciate Dr Targher and colleagues' comments1 about our study.2 The authors raise two important questions: how exactly the cohort of individuals with chronic liver disease (CLD) was selected and why cardiovascular mortality (CVM) was not independently associated with CLDs.

We would like to provide additional clarification. First, regarding the inclusion criteria for alcoholic liver disease (ALD), we included data from both self-reported excessive alcohol consumption and abnormal liver enzymes. Individuals with excessive alcohol consumption accompanied by normal liver enzymes were not excluded from the entire study. Nevertheless, they were not considered as having ALD or CLD and were not included in the ‘healthy control’ group. Given the relatively low threshold selected for the definition of excessive alcohol consumption, we believe that without at least some evidence of liver damage (elevated aminotransferases), we could not model ALD reliably into our study design. Second, the overlaps between the subgroups of CLDs were also not excluded from the study; …

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