Chang Y, Ryu S, Cho J, Rampal S, Zhang Y, Zhao D, Choi Y, Ahn J, Cainzos-Achirica M, Pastor-Barriuso R, Lima JA, Shin H, Guallar E. Non-alcoholic fatty liver disease, insulin resistance, and the risk of incident ischemic heart disease and stroke – the Kangbuk Samsung Health Study. Poster presented at the American Heart Association – American Stroke Association EPI-Lifestyle 2015; March 2015. Baltimore, MD. [abstract] Circulation. 2015 Mar 10; 131(Suppl 1).


OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance (IR) and with other metabolic abnormalities, but the association of NAFLD with the risk of clinical cardiovascular disease (CVD) is controversial. Furthermore, the risk associated with the combination of NAFLD and IR has not been evaluated in prospective studies. The aim of this study was to evaluate the association of NAFLD with or without IR on the incidence of coronary heart disease (CHD) and stroke.

METHODS: We performed a cohort study in 166,126 adults without CVD at baseline who underwent a health checkup exam during 2008 - 2011 and were followed-up through December 31, 2012 (average follow-up of 3.2 years). NAFLD was defined as hepatic steatosis on ultrasonography in the absence of excessive alcohol use or other identifiable causes. IR was defined as a homeostasis model assessment of IR (HOMA-IR) value greater than or equal to 2.5. Incident hospitalizations for CHD events and strokes were ascertained through data linkage with the Korean Health Insurance Review and Assessment Service (HIRA) database.

RESULTS: At baseline, the prevalence of NAFLD and of IR were 25.1 and 6.3%, respectively. During follow-up, 831 participants developed CHD and 582 subjects developed stroke. After adjusting for age, sex, center, year of screening exam, BMI, smoking, alcohol intake, physical activity, family history of CVD, and education, the hazard ratios (95 % confidence intervals) for CHD comparing NAFLD without IR, IR without NAFLD, and NAFLD with IR vs. no NAFLD without IR were 1.07 (0.91 - 1.27), 1.19 (0.74 - 1.91) and 1.55 (1.18 - 2.03), respectively. The corresponding hazard ratios for stroke were 0.93 (0.75 - 1.16), 1.40 (0.83 - 2.35) and 1.82 (1.32 - 2.52), respectively. The P-values for the interaction of NAFLD and IR for CHD and stroke were 0.48 and 0.28, respectively. These associations did not differ by clinically relevant subgroups.

CONCLUSIONS: The combination of NAFLD and IR was associated with an increased incidence of CHD and of stroke, but this was not observed in those with either NAFLD or IR alone. The combination of NAFLD and IR may identify individuals at high cardiometabolic risk who may need to receive more intensive preventive intervention.

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