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Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease
  1. Vincent Wai-Sun Wong1,2,
  2. Grace Lai-Hung Wong1,2,
  3. Gabriel Wai-Kwok Yip1,
  4. Angeline Oi-Shan Lo1,2,
  5. Jenny Limquiaco1,2,3,
  6. Winnie Chiu-Wing Chu2,4,
  7. Angel Mei-Ling Chim1,2,
  8. Cheuk-Man Yu1,
  9. Jun Yu1,2,
  10. Francis Ka-Leung Chan1,2,
  11. Joseph Jao-Yiu Sung1,2,
  12. Henry Lik-Yuen Chan1,2
  1. 1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
  2. 2Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
  3. 3Section of Gastroenterology and Hepatology, Chong Hua Hospital, Cebu, the Philippines
  4. 4Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong
  1. Correspondence to Henry LY Chan, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F, Prince of Wales Hospital, 30–32 Ngan Shing Street, Shatin, Hong Kong; hlychan{at}


Objective Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and is associated with cardiovascular risk. The aim of this study was to determine the role of fatty liver in predicting coronary artery disease and clinical outcomes in patients undergoing coronary angiogram.

Methods This was a prospective cohort study carried out in a University hospital. Consecutive patients who underwent coronary angiogram had ultrasound screening for fatty liver. Significant cardiovascular disease was defined as ≥50% stenosis in at least one coronary artery. The primary outcome was a composite end point comprising cardiovascular deaths, non-fatal myocardial infarction and the need for further coronary intervention during prospective follow-up.

Results Among 612 recruited patients, 356 (58.2%) had fatty liver by ultrasonography, 318 (52.0%) had elevated serum alanine aminotransferase and 465 (76.0%) had significant coronary artery disease. Coronary artery disease occurred in 84.6% of patients with fatty liver and 64.1% of those without fatty liver (p<0.001). After adjusting for demographic and metabolic factors, fatty liver (adjusted OR 2.31; 95% CI 1.46 to 3.64) and alanine aminotransferase level (adjusted OR 1.01; 95% CI 1.00 to 1.02) remained independently associated with coronary artery disease. At a mean follow-up of 87±22 weeks, 30 (10.0%) patients with fatty liver and 18 (11.0%) patients without fatty liver reached the composite clinical end point (p=0.79).

Conclusions In patients with clinical indications for coronary angiogram, fatty liver is associated with coronary artery disease independently of other metabolic factors. However, fatty liver cannot predict cardiovascular mortality and morbidity in patients with established coronary artery disease.

  • Obesity
  • diabetes
  • myocardial infarction
  • alanine aminotransferase
  • fatty liver
  • liver
  • liver function test
  • obesity

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  • Funding The study was partially supported by the research fund of the Department of Medicine and Therapeutics, The Chinese University of Hong Kong.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Clinical Research Ethics Committee, The Chinese University of Hong Kong (CRE-2007.317).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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