title: Long-term clinical outcomes after fatty liver screening in patients undergoing coronary angiogram: A prospective cohort study.
abstract: There is ongoing debate on whether screening for nonalcoholic fatty liver disease (NAFLD) is worthwhile in high-risk groups. Because of shared risk factors, NAFLD is highly prevalent in patients with coronary artery disease. We aimed to test the hypothesis that NAFLD screening in patients requiring coronary angiogram would identify high-risk patients and predict long-term clinical outcomes. This was a prospective cohort study. NAFLD screening was performed by abdominal ultrasonography before coronary angiogram in 612 consecutive patients. At baseline, 356 (58.2%) patients had NAFLD. NAFLD patients, compared with those without, were more likely to have >50% stenosis in one or more coronary arteries (84.6% vs. 64.1%; P < 0.001) and therefore require percutaneous coronary intervention (68.3% vs. 43.4%; P < 0.001). During 3,679 patient-years of follow-up, 47 (13.2%) NAFLD patients and 59 (23.0%) patients without NAFLD died (age- and sex-adjusted hazard ratio [aHR]: 0.36; 95% confidence interval [CI]: 0.18-0.70; P = 0.003). Composite cardiovascular outcomes (cardiovascular deaths, nonfatal myocardial infarction, heart failure, or secondary interventions) were similar between groups (36.5% vs. 37.1%; aHR, 0.90; 95% CI: 0.69-1.18). Older age and diabetes were the only independent factors associated with cardiovascular events. Only 2 patients, both in the NAFLD group, died of primary liver cancer. No other patients developed liver-related complications.
  
  
  CONCLUSIONS
  In patients with clinical indications for coronary angiogram, the presence of NAFLD is associated with coronary artery stenosis and need for coronary intervention, but not increased mortality or cardiovascular complications. Liver cancer and cirrhotic complications are rare. Our data do not support NAFLD screening in this patient group at present, but studies with a longer duration of follow-up are needed.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.|State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Vincent Wai-Sun
authors.initials: VW
authors.lastname: Wong
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.|State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Grace Lai-Hung
authors.initials: GL
authors.lastname: Wong
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Judy Ching-Lam
authors.initials: JC
authors.lastname: Yeung
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Chloe Yuk-Kiu
authors.initials: CY
authors.lastname: Fung
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Jasmine Ka-Lei
authors.initials: JK
authors.lastname: Chan
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Zoe Hoi-Yi
authors.initials: ZH
authors.lastname: Chang
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Chelsia Tsz-Yan
authors.initials: CT
authors.lastname: Kwan
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Hiu-Wan
authors.initials: HW
authors.lastname: Lam
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.|Chong Hua Hospital, Cebu City, Philippines.
authors.forename: Jenny
authors.initials: J
authors.lastname: Limquiaco
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.|State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Angel Mei-Ling
authors.initials: AM
authors.lastname: Chim
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.|State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Henry Lik-Yuen
authors.initials: HL
authors.lastname: Chan
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications* / Q000401:mortality; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D011446:Prospective Studies; D014463:Ultrasonography