Alcohol-related liver disease poses increased risk of cardiovascular disease

Patients with biopsy-proven alcohol-related liver disease (ALD) appear to have a higher frequency of cardiovascular disease (CVD) than their counterparts without ALD, according to a study. The increased rates are especially pronounced just after ALD diagnosis.

Researchers examined the risk of CVD outcomes in 3,488 patients with ALD and an available liver biopsy in comparison with a matched reference population of 15,461 individuals. They used competing risk regression, taking non-CVD death into account and controlling for potential confounders, in the analyses.

The ALD group had a median age of 58.0 8 years; 64 percent were men, and 58 percent had cirrhosis at baseline. In terms of comorbidities, 11.8 percent had previously diagnosed diabetes, 9.3 percent had hypertension, and 16.2 percent had previous liver decompensation.

Over a median follow-up of 4.2 years, 864 patients with ALD sustained a CVD event (24.8 percent). On the other hand, 4,517 individuals in the reference group had a first CVD event over a longer follow-up, which was a median of 14.7 years. More than half (56 percent) of the ALD population died due to non-CVD causes as opposed to only 14 percent in the reference group.

Multivariable analyses confirmed that the incidence rate of CVD was higher in the ALD than in the reference group (35.6 vs 19.0 per 1,000 person-years). ALD contributed to a twofold increase in the short-term risk of CVD (first year after diagnosis: subdistribution hazard ratio, 2.29, 95 percent confidence interval, 1.79–2.95), but this risk decreased with time.

Incidence rates of CVD were similar across histological subgroups, ranging from 27.4 CVD cases/1,000 person-years among patients with normal histology to 39.2/1,000 person-years among those with cirrhosis.

The findings highlight the importance of active surveillance of modifiable CVD risk factors in the treatment of patients with ALD.