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The association between changes in hepatic steatosis and hepatic fibrosis with cardiovascular outcomes and mortality in patients with New-Onset type 2 Diabetes: A nationwide cohort study

  • Author Footnotes
    1 These two authors contributed equally.
    Jiyun Park
    Footnotes
    1 These two authors contributed equally.
    Affiliations
    Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea

    Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Author Footnotes
    1 These two authors contributed equally.
    Gyuri Kim
    Footnotes
    1 These two authors contributed equally.
    Affiliations
    Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Bong-Sung Kim
    Affiliations
    Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
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  • Kyung-Do Han
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
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  • So Yoon Kwon
    Affiliations
    Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • So Hee Park
    Affiliations
    Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • You-Bin Lee
    Affiliations
    Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Sang-Man Jin
    Affiliations
    Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Jae Hyeon Kim
    Correspondence
    Corresponding authors.
    Affiliations
    Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Seoul, Republic of Korea
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  • Author Footnotes
    1 These two authors contributed equally.
Published:November 26, 2022DOI:https://doi.org/10.1016/j.diabres.2022.110191

      Highlights

      • Persistent NAFLD showed increased risk of myocardial infarction, stroke, heart failure, and mortality compared with non-NAFLD.
      • Regression NAFLD was associated with decreased risk HF and mortality compared with persistent NAFLD.
      • Persistent hepatic fibrosis was associated with increased risk of stroke, heart failure and mortality compared with non-fibrosis.
      • Compared with persistent hepatic fibrosis, regression of hepatic fibrosis demonstrated decreased risk of MI, stroke, HF, and mortality.
      • Changes in hepatic steatosis and fibrosis based on FLI or BARD score could identify higher risk group for CVD and mortality among new-onset T2DM.

      Abstract

      Aim

      Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) have a synergistic effect on cardiovascular disease (CVD). We investigated the association of changes in hepatic steatosis and advanced hepatic fibrosis with risk of CVD and mortality in new-onset T2DM.

      Methods

      Using the Korean National Health Insurance dataset, we included 120,256 patients with new-onset T2DM. Hepatic steatosis and advanced hepatic fibrosis were determined using the fatty liver index (FLI) and BARD score. According to the changes of the two scores over two years, patients were divided into four groups and analyzed for development of myocardial infarction (MI), stroke, heart failure (HF), and mortality.

      Results

      Incident hepatic steatosis was associated with increased development of stroke, HF, and mortality compared with non-NAFLD (all p < 0.05). Regression and persistent hepatic steatosis were associated with increased risk of MI, stroke, HF, and mortality compared with non-NAFLD (all p < 0.05). Persistent advanced hepatic fibrosis was associated with increased risk of stroke, HF, and mortality (all p < 0.05).) Compared with persistent hepatic fibrosis, regression of hepatic fibrosis was associated with decreased risk of stroke, HF, and mortality (all p < 0.05).

      Conclusions

      Changes in FLI or BARD score were associated with CVD and mortality in new-onset T2DM.

      Keywords

      Abbreviations:

      BMI (body mass index), CI (confidence interval), CVD (cardiovascular disease), FLI (fatty liver index), HF (heart failure), HR (hazard ratio), MI (myocardial infarction), NAFLD (Nonalcoholic fatty liver disease)
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