title: Prevalence and prediction of coronary artery disease in patients with liver cirrhosis: a registry-based matched case-control study.
abstract: BACKGROUND
  There is conflict regarding the prevalence of coronary artery disease (CAD) in patients with liver cirrhosis. This study aimed to investigate the prevalence of silent CAD in comparison with the general population, and to identify the relevant risk factors in patients with liver cirrhosis.
  
  
  RESULTS
  This retrospective study included 1045 prospectively registered consecutive patients with liver cirrhosis without any history of chest pain or CAD, who underwent computerized coronary angiography as a pretransplant workup. These were matched with 6283 controls with healthy livers, based on propensity scores according to established cardiovascular risk factors. Obstructive CAD was defined as ≥50% luminal narrowing in any artery. A matched analysis of 853 pairs showed that the proportion of subjects with obstructive CAD did not differ significantly between the cirrhotic and control groups (7.2% versus 7.9%, P=0.646), in agreement with the outcome of multivariate analysis for its predictors, with an adjusted odds ratio for liver cirrhosis of 1.06 (P=0.690). Nonobstructive CAD was more prevalent in the matched cirrhotic cases (30.6% versus 23.4%, P=0.001). In the pooled cirrhotic cohort, older age, male sex, hypertension, diabetes mellitus, and alcoholic cirrhosis were independently associated with obstructive CAD (adjusted odds ratios, 1.07, 2.74, 1.69, 2.37, and 2.17, respectively; P<0.05 for all), whereas liver function and coagulation parameters were not.
  
  
  CONCLUSIONS
  Asymptomatic cirrhotic patients and nonhepatic subjects are similar in terms of the prevalence of occult obstructive CAD. Traditional cardiovascular risk factors are related to critical coronary stenosis in cirrhotic patients, and thus may be helpful indicators for more careful preoperative evaluation of coronary risk.
authors.affiliation: From the Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.A., J.H.S., D.L., K.M.K., Y.-S.L., H.C.L., Y.-H.C., Y.S.L.); and the Department of Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-O.K.).
authors.forename: Jihyun
authors.initials: J
authors.lastname: An
authors.affiliation: From the Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.A., J.H.S., D.L., K.M.K., Y.-S.L., H.C.L., Y.-H.C., Y.S.L.); and the Department of Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-O.K.). s5854@medimail.co.kr.
authors.forename: Ju Hyun
authors.initials: JH
authors.lastname: Shim
authors.affiliation: From the Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.A., J.H.S., D.L., K.M.K., Y.-S.L., H.C.L., Y.-H.C., Y.S.L.); and the Department of Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-O.K.).
authors.forename: Seon-Ok
authors.initials: SO
authors.lastname: Kim
authors.affiliation: From the Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.A., J.H.S., D.L., K.M.K., Y.-S.L., H.C.L., Y.-H.C., Y.S.L.); and the Department of Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-O.K.).
authors.forename: Danbi
authors.initials: D
authors.lastname: Lee
authors.affiliation: From the Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.A., J.H.S., D.L., K.M.K., Y.-S.L., H.C.L., Y.-H.C., Y.S.L.); and the Department of Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-O.K.).
authors.forename: Kang Mo
authors.initials: KM
authors.lastname: Kim
authors.affiliation: From the Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.A., J.H.S., D.L., K.M.K., Y.-S.L., H.C.L., Y.-H.C., Y.S.L.); and the Department of Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-O.K.).
authors.forename: Young-Suk
authors.initials: YS
authors.lastname: Lim
authors.affiliation: From the Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.A., J.H.S., D.L., K.M.K., Y.-S.L., H.C.L., Y.-H.C., Y.S.L.); and the Department of Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-O.K.).
authors.forename: Han Chu
authors.initials: HC
authors.lastname: Lee
authors.affiliation: From the Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.A., J.H.S., D.L., K.M.K., Y.-S.L., H.C.L., Y.-H.C., Y.S.L.); and the Department of Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-O.K.).
authors.forename: Young-Hwa
authors.initials: YH
authors.lastname: Chung
authors.affiliation: From the Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.A., J.H.S., D.L., K.M.K., Y.-S.L., H.C.L., Y.-H.C., Y.S.L.); and the Department of Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-O.K.).
authors.forename: Yung Sang
authors.initials: YS
authors.lastname: Lee
mesh_terms: D058070:Asymptomatic Diseases / Q000453:epidemiology; D016022:Case-Control Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000453:epidemiology*; D008104:Liver Cirrhosis, Alcoholic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011237:Predictive Value of Tests; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: coronary artery disease, prevalence; coronary computed tomography angiography; liver cirrhosis, asymptomatic