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Table 4. Association between liver fibrosis assessed by elastographic techniques and cardiovascular outcomes/mortality

Author F-up CVD/mortality Clinical variables
(ref.) Study characteristics (year) NAFLD (%) Fibrosis (%) Outcomes (%) Main findings at MVA for adjustment/covariates
Cross-sectional

Friedrich- 505 consecutive patients - 71.5% (CAP ≥ 11.2% NAFLD with 70.5% High-grade CAD is independently predicted by Sex, hypertension, and hip-waist-
[94]
Rust et al. undergoing elective coronary 234 dB/m) advanced LF (VCTE CHD 3 (stenosis ≥ NAFLD but not NAFLD with advanced LF ratio
angiography for various LSM ≥ 7.9kPa) 75%)
indications, 78.2% men, mean
age 65.7 years
[95]
Song et al. 120 consecutive patients with - 67% in non- 2DSWE-SSI (kPa) 4.82 50% LSM (by 2D-SWE SSI), age, male sex, total T2D, hypertension, smoking, HDL-C,
suspect CHD submitted to CHD, ± 0.92 in non-CHD vs. CHD cholesterol, and visceral fat thickness were LDL-C, HbA1c,
coronary angiography or CTA 95% in CHD 6.37 ± 1.39 in CHD determinants of CHD NAFLD
(n.60 CHD and n.60 non-CHD)
Lombardi 394 T2D outpatients from 5 - 89% (US) 21% significant LF 19% CVD (prior MI Significant LF was independently associated with Age, sex, smoking, cardiometabolic
[96]
et al. diabetes centers, 52% men, 72% (CAP ≥ (VCTE LSM ≥ 7.0/6.2 and/or IS), 33% prior CVD (OR 3.3) and the presence of risk factors, diabetes-related
mean age 68 ± 10 years 248 dB/m) kPa by M/XL probe) microvascular microvascular complications (OR 4.2), mainly variables, severe US steatosis
complications CKD (OR 3.6) and retinopathy (OR 3.7)
Mantovani 137 consecutive patients with - 73.7% (US) 17.5% (VCTE LSM ≥ 7 20.4% CV CV complications (previous CHD, IS, permanent Age, sex, cardiometabolic risk
[97]
et al. non-insulin-treated T2D, kPa) or 10.2% complications (medical AF) increased across LSM tertiles (from around factors, diabetes-related variables,
52.8% women, mean age 69.9 (LSM ≥ 8.7 kPa) history) 15% to 30%). At MVA, LSM tertile 3 remained CRP levels
± 7 years significant LF significantly associated with an increased risk of
prevalent CKD but not with cardiovascular
complications

Mikolasevic 442 outpatients with - 84.2% (CAP 46.6% significant LF 25% macrovascular Significant LF but not steatosis was Age, sex, cardiometabolic risk
[98]
et al. established T2D, 52.7% ≥ 238 dB/m) (VCTE LSM ≥ 7.0/6.2 complications (MI, IS) independently associated with MI (OR 6.61), factors, diabetes-related variables,
women, median (IQR) age 62 kPa by M/XL probe) (at least one) (medical peripheral polyneuropathy (OR 4.55), CKD (OR CRP levels
(53-68) years history) 4.54), and retinopathy (OR 1.81)
[99]
Long et al. 3276 Framingham Heart Study - 28.8% 8.8% significant LF - LF was associated with multiple CVD risk factors Age, sex, smoking, alcohol, physical
adult participants, 54% (CAP ≥ 290 (VCTE LSM ≥ 8.2 kPa) (obesity: OR 1.82; MetS: OR 1.49; diabetes: OR activity, aminotransferases, and CAP
women, mean age 54 ± 9 years dB/m) 2.67, hypertension: OR 1.52; low HDL-C: OR
1.47)
Pennisi 542 subjects from a - 31.7% (CAP > 4.8% severe LF (VCTE 22.2% high-risk ASCVD Both steatosis (OR 1.62, 95%CI: 1.13-2.33) and Age, BMI
[100]
et al. community-based study, 59% 288 dB/m) LSM ≥ 9.6/9.3 kPa by score severity of
women, mean age of 58 ± 10 M/XL probe) fibrosis (OR 1.67, 95%CI: 1.18-2.36) were
years independently associated with higher ASCVD
[101]
Park et al. 105 patients with NAFLD, 52% - 100% (MRI- 35.2% significant LF 49.5% CAC > 0 LS was independently associated with the Age, sex, smoking, total cholesterol,
women, mean age of 55 years PDFF ≥ 5%) (MRE ≥ 2.97 kPa) presence of CAC in a sex and age-adjusted HDL-C, SBP, medication for
model (OR 2.23; 95%CI: 1.31-4.34) as well as in hypertension, T2D, and history of
an FRS-adjusted model (OR 2.16, 95%CI: 1.29- CVD
4.09)
Ciardullo 2734 subjects from NHANES - 48.6% (CAP 9.7% significant LF 12% Neither steatosis nor significant fibrosis was Age, sex, race-ethnicity, BMI, T2D,
[102]
et al. 2017-2018, 53% women, mean ≥ 274 dB/m) (VCTE LSM ≥ 8 kPa) (9% CHD) independently associated with CVD smoking, CKD
age 59 years