Nonalcoholic Fatty Liver Disease (NAFLD) is associated with insulin resistance, type 2 diabetes (T2DM) and cardiovascular disease. However, data on NAFLD in patients with established cardiovascular disease (CVD) are scarce. We therefore aimed at investigating its association with T2DM as well as its impact on cardiovascular event risk in a large series of 1518 patients with established CVD (1274 patients with angiographically proven coronary artery disease and 244 patients with sonographically proven peripheral artery disease), using the validated fatty liver index for the diagnosis of NAFLD. At baseline, the prevalence of NAFLD was significantly higher in patients with T2DM than in nondiabetic subjects (61.3 vs. 39.8%; p<0.001) respectively. Prospectively, we recorded 738 cardiovascular events over a mean follow-up period of 9.7±4.6 years. Cardiovascular event risk was significantly higher in NAFLD patients than in those who did not have NAFLD (52.0 vs. 46.4%; p=0.040) and in patients with T2DM than in nondiabetic subjects (58.2 vs. 44.8%; p<0.001). Cox regression models adjusting for conventional cardiovascular risk factors proved NAFLD and T2DM to be mutually independent predictors of cardiovascular events, with adjusted hazard ratios of 1.44 [1.19-1.74]; p<0.001 and 1.45 [1.24-1.9]; p<0.001, respectively. We conclude that NAFLD and T2DM are mutually independent predictors of cardiovascular events in patients with established CVD.
C.H. Saely: None. A. Vonbank: None. M. Maechler: None. B. Larcher: None. L. Sprenger: None. A. Mader: None. D. Purin: None. M. Klement: None. A. Leiherer: None. A. Muendlein: None. H. Drexel: None.