Acute Coronary Syndromes in patients with Non Alcoholic Fatty Liver Disease

Background: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. NAFLD, and more so, steatohepatitis (NASH) is primarily associated with increased cardiovascular mortality.

Our purpose was to study biomarkers predicting advanced stage of liver fibrosis and cirrhosis and their association with the occurrence of acute coronary events in a population of patients with known Fatty liver disease.

Methods: 54 patients with a non-invasive diagnosis of NAFLD were studied. We Performed follow up visits including physical examinations and biochemical analyses.

NAFLD Fibrosis Score (NFS) and Fib-4 Score were used to assess the severity of disease; both have been extensively validated in cohorts of patients with NAFLD.

We retrospectively identified the sub population of patients with a history of Acute Coronary Syndromes (ACS) and a proven angiographically documented obstructive lesion in at least one of the coronary arteries. The profile of the patients with fatty liver with and without ACS was studied comparatively.

Results: 7 patients (13% of 54) had a prior coronary event from time of NAFLD diagnosis to the incident follow up visit. Patients with ACS had higher values of NFS and FIB-4 than patients with no history of ACS, (-0.33 vs. -0.9, P=0.31 and 2.76 vs. 1.62, P= 0.0178 respectively).

Conclusion: Thus, patients with Fatty liver and ACS have significantly higher biomarkers of fibrosis. This suggest that biomarkers of fibrosis should be further studied as an independent predictor of future coronary event