title: The Association between Non-Invasive Hepatic Fibrosis Markers and Cardiometabolic Risk Factors in the Framingham Heart Study.
abstract: OBJECTIVE
  Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular related death, particularly in those with hepatic fibrosis. We determined the prevalence of predicted fibrosis based on non-invasive fibrosis markers and the association of hepatic fibrosis with cardiovascular risk factors.
  
  
  METHODS
  Cross-sectional study of 575 Framingham Heart Study participants with NAFLD based on computed tomography. We determined the prevalence of predicted fibrosis based on the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, AST to platelet ratio index (APRI), the Fibrosis-4 score (FIB4), and the NAFLD Fibrosis Score (NFS). Using multivariable logistic regression models, we examined the association between low, indeterminate, or high risk for fibrosis according to the NFS and various cardiometabolic risk factors.
  
  
  RESULTS
  The predicted risk of fibrosis was 12%, 4%, 5%, and 32% for the NFS, FIB4, APRI, and AST/ALT ratio, respectively. In multivariable models, participants with a high risk for advanced fibrosis by the NFS had a wider pulse pressure (adjusted mean difference = 6.87 mm Hg; p = 0.0002) and an increased odds of hypertension (OR 2.92; p = 0.007) compared to those with low risk of fibrosis. There were no statistically significant differences between other cardiovascular risk factors for those with a high versus low risk of fibrosis.
  
  
  CONCLUSIONS
  The AST/ALT ratio, APRI, and NFS give widely disparate predictions of liver fibrosis. Participants with a high risk for fibrosis based on NFS had wider pulse pressure and increased odds of hypertension. Whether modifying these risk factors impacts cardiovascular endpoints in NAFLD patients remains unknown.
authors.affiliation: Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States of America.|National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, United States of America.
authors.forename: Michelle T
authors.identifier: http://orcid.org/0000-0001-6131-3981
authors.initials: MT
authors.lastname: Long
authors.affiliation: National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, United States of America.|Merck Research Laboratories, Kenilworth, New Jersey, United States of America.
authors.forename: Alison
authors.initials: A
authors.lastname: Pedley
authors.affiliation: National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, United States of America.|Department of Mathematics and Statistics, Boston University, Boston, Massachusetts, United States of America.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Massaro
authors.affiliation: Radiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, United States of America.|Division of Endocrinology, Hypertension, and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
mesh_terms: D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000150:complications*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors
chemical_list: D015415:Biomarkers