Alcohol use and cardiovascular disease risk in patients with nonalcoholic fatty liver disease
Open accessAbstract
Background & aims Cardiovascular disease (CVD) is the leading cause of death among patients with nonalcoholic fatty liver disease (NAFLD). Moderate drinking (vs abstinence) is associated with lower risk of CVD in the general population. We assessed whether alcohol use is associated with CVD risk in patients with NAFLD.Methods We analyzed data from participants in the Coronary Artery Risk Development in Young Adults longitudinal cohort study of 5115 black and white young adults, 18-30 years old, recruited from 4 cities in the United States from 1985 through 1986. Participants self-reported alcohol use at study entry and then again after 15, 20, and 25 years. At year 25 (2010-2011), participants underwent computed tomography examination of the thorax and abdomen and tissue Doppler echocardiography with myocardial strain measured by speckle tracking. Coronary artery calcification was defined as an Agatston score above 0. NAFLD was defined as liver attenuation <51 Hounsfield Units after exclusions. Drinkers reported 1-21 (men) or 1-14 (women) standard drinks/week at years 15, 20, or 25. Nondrinkers reported no alcohol use at years 15, 20, and 25.Results Of the 570 participants with NAFLD (mean age, 50 years; 54% black; 46% female), 332 (58%) were drinkers; significantly higher proportions of drinkers were white, male, and with higher levels of education compared with nondrinkers (P < .05 for all). Higher proportions of drinkers had obesity, diabetes, and metabolic syndrome compared with nondrinkers (P < .01). There was no difference in liver attenuation between groups (P = .12). After multivariable adjustment, there was no association between alcohol use and CVD risk factors (diabetes, hypertension, hyperlipidemia) or subclinical CVD measures (coronary artery calcification, early transmitral velocity/late (atrial) transmitral velocity (E/A) ratio, global longitudinal strain).Conclusions In a population-based sample of individuals with NAFLD in midlife, prospectively assessed alcohol use is not associated with significant differences in risk factors for CVD or markers of subclinical CVD. In contrast to general population findings, alcohol use may not reduce the risk of CVD in patients with NAFLD.
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The evidence for cardiovascular protection is conflicting in individuals with MASLD, with a documented lack of protection towards subclinical atherosclerotic markers or lesions.
“Finally, the evidence for cardiovascular protection is con fl icting in individuals with MASLD, 98 with a documented lack of protection towards subclinical atherosclerotic markers or lesions.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [99]
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- Authors
- VanWagner, L. B., Ning, H., Allen, N. B., Ajmera, V., Lewis, C. E., Carr, J. J., Lloyd-Jones, D. M., Terrault, N. A., & Siddique, J.
- Affiliations
- Northwestern University (US)
- University of California, San Francisco (US)
- University of Alabama (US)
- Vanderbilt University (US)
- Corresponding author
- VanWagner, Lisa B.
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 153
- Issue
- 5
- Pages
- 1260-1272.e3
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC5669829
- OpenAlex
- W2744905099
- Cited by
- 74
- References
- 62
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 9 · 2023: 11 · 2022: 6 · 2021: 12 · 2020: 12 · 2019: 9 · 2018: 8 · 2017: 1
- FWCI
- 6.44
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (KL2TR001424, R01-HL-098445, AG0005)
- National Center for Advancing Translational Sciences (KL2TR001424, R01-HL-098445, AG0005)
- National Institutes of Health (KL2TR001424, R01-HL-098445, AG0005)
- National Institute on Aging (KL2TR001424, R01-HL-098445, AG0005)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- non-alcoholic fatty liver disease, alcohol consumption, cardiovascular risk, coronary artery calcification, myocardial strain, subclinical cardiovascular disease, young adults, metabolic syndrome, liver attenuation, cardiovascular risk factors, sex differences, racial differences, obesity, diabetes mellitus, hypertension, hyperlipidemia, liver fibrosis staging
- MeSH terms
- Underage Drinking, Adolescent, Adult, Age Factors, Alcohol Drinking, Coronary Artery Disease, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Male, Middle Aged, Prognosis, Risk Factors, Time Factors, United States, Echocardiography, Doppler, Multivariate Analysis, Chi-Square Distribution, Linear Models, Logistic Models, Odds Ratio, Risk Assessment, Young Adult, Multidetector Computed Tomography, Binge Drinking, Non-alcoholic Fatty Liver Disease, Protective Factors
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