Nonalcoholic fatty liver disease is associated with coronary artery calcification: A systematic review and meta-analysis

Background: Nonalcoholic fatty liver disease (NAFLD) is associated increased cardiovascular events and mortality. Coronary artery calcium scanning (CAC) is the robust predictor of coronary events in the asymptomatic individuals. Several recent studies have investigated the association between NAFLD and this surrogate marker. Thus, we conducted a systematic review and meta-analysis to better characterize the association between NAFLD and CAC.

Methods: MEDLINE and EMBASE were searched through May 2016. Primary outcome was the association between NAFLD and CAC. Pooled odds ratio (OR) and 95% confidence interval (CI) from multivariable-adjusted estimates were calculated using a random-effects model. The between-study heterogeneity of effect-size was quantified using the Q statistic and I².

Results: Data were extracted from 16 studies (all cross-sectional studies) involving 16,433 NAFLD patients and 41,717 controls. NAFLD is significantly associated with CAC score >0 and CAC score >100 with pooled OR of 1.41 (95%CI 1.26-1.57, P_{heterogeneity}=0.07, I²=66%) and 1.24 (95%CI 1.02-1.52, P_{heterogeneity}=0.10, I²=42%).

Conclusions: NAFLD is associated with increased coronary artery calcification independent of traditional risk factors. The assessment of coronary artery calcium may be useful in identifying NAFLD patients at risk of future cardiovascular events.