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J Gastroenterol Hepatol. 2019 Sep 11. doi: 10.1111/jgh.14856. [Epub ahead of print]

Nonalcoholic Fatty Liver Disease and the Incidence of Myocardial Infarction: A Cohort Study.

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Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
Center for Total Health Studies, Kangbuk Samsung Hospital, Seoul, South Korea.
Center for Health Promotion, Samsung Medical Center, Seoul, South Korea.
National Center for Epidemiology, Instituto de Salud Carlos III, and Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP),, Madrid, Spain.
Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, USA.



Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease associated with an increased risk of cardiovascular disease (CVD), diabetes, and chronic kidney disease. Indeed, CVD is the most common cause of death in NAFLD patients. This study aimed to evaluate the association between NAFLD and the risk of incident myocardial infarction.


Thus is a retrospective cohort study involving 111,492 adults over 40 years old without history of CVD, liver disease or cancer at baseline who participated in a regular health screening exam between 2003 and 2013. Fatty liver was diagnosed by ultrasonography.


During 725,706.9 person-years of follow-up, 183 participants developed myocardial infarction (incidence rate 0.3 cases per 1,000 person-years). The age, sex, and year of visit-adjusted hazard ratio (HR) for incident myocardial infarction comparing participants with NAFLD to those without it was 2.14 (95% CI 1.59, 2.89). This association remained significant in fully-adjusted models (HR 1.54; 95% CI 1.11, 2.14). Compared to participants without NAFLD, the fully-adjusted HR for incident myocardial infarction in participants with low NFS (< -1.455) and with intermediate to high NFS (≥ -1.455) were 1.70 (1.22, 2.36) and 1.88 (1.24, 2.87), respectively.


In this large cohort study, NAFLD was associated with an increased incidence of myocardial infarction independently of established risk factors. In addition, this association was similar in participants with and without evidence of more advanced NAFLD as indicated by the NFS score. NAFLD patients may need to be carefully monitored and managed early to prevent myocardial infarction.


Fibrosis; Myocardial Infarction; Nonalcoholic Fatty Liver Disease; Risk Factor


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