title: Nonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular disease in adult patients with type 1 diabetes.
abstract: BACKGROUND
  Recent studies suggested that nonalcoholic fatty liver disease (NAFLD) is associated with an increased prevalence of cardiovascular disease (CVD) in type 1 diabetes. We assessed whether NAFLD also predicts the risk of incident CVD events in type 1 diabetic adults.
  
  
  METHODS
  We studied a retrospective cohort of 286 type 1 diabetic outpatients (mean age 43±14years; median duration of diabetes 17 [10-30] years) without secondary causes of chronic liver diseases, who were followed for a mean period of 5.3years for the occurrence of incident CVD events (a combined endpoint inclusive of nonfatal ischemic heart disease, nonfatal ischemic stroke or coronary/peripheral artery revascularizations). NAFLD was diagnosed by ultrasonography.
  
  
  RESULTS
  Overall, 150 patients (52.4%) had NAFLD at baseline. During a mean follow-up of 5.3±2.1years, 28 patients developed incident CVD events. Patients with NAFLD had a higher incidence of CVD events than those without NAFLD (17.3% vs. 1.5%, p<0.001). NAFLD was associated with an increased risk of CVD events (hazard ratio [HR] 8.16, 95% confidence interval [CI] 1.9-35.1, p<0.005). Adjustments for age, sex, body mass index, smoking, diabetes duration, hemoglobin A1c, dyslipidemia, hypertension, chronic kidney disease, prior ischemic heart disease and serum gamma-glutamyltransferase levels did not appreciably attenuate the association between NAFLD and incident CVD (adjusted-HR 6.73, 95% CI 1.2-38.1, p=0.031).
  
  
  CONCLUSIONS
  This is the first observational study to demonstrate that NAFLD is associated with an increased risk of incident CVD events in type 1 diabetic adults, independently of established CVD risk factors and diabetes-related variables.
authors: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Integrata of Verona, Verona, Italy. Electronic address: alessandro.mantovani24@gmail.com.
authors: Alessandro
authors: A
authors: Mantovani
authors: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Integrata of Verona, Verona, Italy.
authors: Lucia
authors: L
authors: Mingolla
authors: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Integrata of Verona, Verona, Italy.
authors: Riccardo
authors: R
authors: Rigolon
authors: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Integrata of Verona, Verona, Italy.
authors: Isabella
authors: I
authors: Pichiri
authors: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Integrata of Verona, Verona, Italy.
authors: Valentina
authors: V
authors: Cavalieri
authors: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Integrata of Verona, Verona, Italy.
authors: Giacomo
authors: G
authors: Zoppini
authors: Section of Clinical Biochemistry, University and Azienda Ospedaliera Integrata of Verona, Verona, Italy.
authors: Giuseppe
authors: G
authors: Lippi
authors: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Integrata of Verona, Verona, Italy.
authors: Enzo
authors: E
authors: Bonora
authors: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Integrata of Verona, Verona, Italy.
authors: Giovanni
authors: G
authors: Targher
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012189:Retrospective Studies
keywords: Cardiovascular disease; NAFLD; Type 1 diabetes