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Impact of Non-Alcoholic Fatty Liver Disease on Late Cardiovascular Events and Death in Chronic Obstructive Pulmonary Disease
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A2388 - Impact of Non-Alcoholic Fatty Liver Disease on Late Cardiovascular Events and Death in Chronic Obstructive Pulmonary Disease
Author Block: D. Viglino1, A. Plazanet1, M. Benmerad2, S. Bailly2, I. Jullian-Desayes2, R. Tamisier2, V. Leroy3, J. Zarski3, M. Maignan1, M. Joyeux-Faure2, J. Pepin2; 1Urgences Médecine Aigue, CHU Grenoble-Alpes, Grenoble, France, 2Thorax et Vaisseaux, Laboratoire EFCR et Sommeil, Grenoble, France, 3Hepato-Gastroenterologie, CHU Grenoble-Alpes, Grenoble, France.
Rationale: Chronic Obstructive Pulmonary Disease (COPD) and Non-Alcoholic Fatty Liver Disease (NAFLD) are frequently associated. Both conditions independently increase cardiovascular risk and the coexistence of NAFLD and COPD might amplify the rate of incident cardiovascular events and death.
Methods: The relationship between NAFLD and incident cardiovascular (CV) events, acute exacerbations of COPD (AECOPD) and death was assessed in a prospective cohort of COPD patients during 5 years of longitudinal follow-up. Noninvasive tests (FibroMax) were used to evaluate steatosis, nonalcoholic steatohepatitis (NASH) and liver fibrosis. Univariate and multivariate analyzes were performed using marginal Cox model for repeated events to assess the impact of liver diseases on acute exacerbation and standard Cox models for composite outcomes (death or CV disease)
Results: Among the 111 COPD patients, 75% exhibited liver injury with a prevalence of steatosis, NASH and fibrosis of 41%, 37% and 61%, respectively. During the 5 year-follow-up, 56 patients experienced exacerbations, 30 at least one cardiovascular event and 7 died. In univariate analysis, patients with liver fibrosis experienced more cardiovascular events and mortality (Hazard ratio [95%CI]: 2.75 [1.26; 6.03]) than those with no fibrosis. This association remained significant in multivariate analysis (Hazard ratio [95%CI]: 2.94 [1.18; 7.33]). Steatosis and NASH were not associated with increased rate of cardiovascular events, AECOPD and mortality.
Conclusion: COPD patients suffering from liver fibrosis exhibited a higher incidence of 5 years cardiovascular events and death. Diagnose liver injury at early stage in COPD might be clinically relevant to improve cardiovascular prognostic of this population.
Author Block: D. Viglino1, A. Plazanet1, M. Benmerad2, S. Bailly2, I. Jullian-Desayes2, R. Tamisier2, V. Leroy3, J. Zarski3, M. Maignan1, M. Joyeux-Faure2, J. Pepin2; 1Urgences Médecine Aigue, CHU Grenoble-Alpes, Grenoble, France, 2Thorax et Vaisseaux, Laboratoire EFCR et Sommeil, Grenoble, France, 3Hepato-Gastroenterologie, CHU Grenoble-Alpes, Grenoble, France.
Rationale: Chronic Obstructive Pulmonary Disease (COPD) and Non-Alcoholic Fatty Liver Disease (NAFLD) are frequently associated. Both conditions independently increase cardiovascular risk and the coexistence of NAFLD and COPD might amplify the rate of incident cardiovascular events and death.
Methods: The relationship between NAFLD and incident cardiovascular (CV) events, acute exacerbations of COPD (AECOPD) and death was assessed in a prospective cohort of COPD patients during 5 years of longitudinal follow-up. Noninvasive tests (FibroMax) were used to evaluate steatosis, nonalcoholic steatohepatitis (NASH) and liver fibrosis. Univariate and multivariate analyzes were performed using marginal Cox model for repeated events to assess the impact of liver diseases on acute exacerbation and standard Cox models for composite outcomes (death or CV disease)
Results: Among the 111 COPD patients, 75% exhibited liver injury with a prevalence of steatosis, NASH and fibrosis of 41%, 37% and 61%, respectively. During the 5 year-follow-up, 56 patients experienced exacerbations, 30 at least one cardiovascular event and 7 died. In univariate analysis, patients with liver fibrosis experienced more cardiovascular events and mortality (Hazard ratio [95%CI]: 2.75 [1.26; 6.03]) than those with no fibrosis. This association remained significant in multivariate analysis (Hazard ratio [95%CI]: 2.94 [1.18; 7.33]). Steatosis and NASH were not associated with increased rate of cardiovascular events, AECOPD and mortality.
Conclusion: COPD patients suffering from liver fibrosis exhibited a higher incidence of 5 years cardiovascular events and death. Diagnose liver injury at early stage in COPD might be clinically relevant to improve cardiovascular prognostic of this population.
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