Background and Aims: It has recently been suggested that the definition of non-alcoholic fatty liver disease (NAFLD) be changed to Metabolic Associated FLD (MAFLD) to better reflect the complex metabolic aspects of this syndrome. We compared the ability of MAFLD and NAFLD to correctly identify high CV risk patients, sub-clinical atherosclerosis or a history of prior CV events (CVEs) in patients living with HIV (PWH). Methods: Single center, cross-sectional study of PWH on stable anti-retrovirals. NAFLD was diagnosed by transient liver elastography; published criteria were used to diagnose MAFLD (JHepatol.2020;73(1):202-209). Four mutually exclusive groups were considered: low (<7.5%) vs high (>7.5%) ASCVD risk, subclinical CVD (carotid IMT ≥1 mm and/or coronary calcium score >100), and prior CVEs. The association of NAFLD and MAFLD with the CVD risk groups was explored via a multinominal model adjusted for age, sex, liver fibrosis, HIV duration, nadir CD4 and current CD4 cell count. Results: We included 1249 PWH (mean age 55 years, 74% men, median HIV duration 24 years). Prevalence of overweight/obesity and diabetes was 40% and 18%. Prevalence of NAFLD and MAFLD and overlapping groups are shown in Fig 1A. Fig 1B shows distribution of NAFLD/MAFLD in the 4 patient categories (p-for-trend <0.001). Both MAFLD and NAFLD were significantly associated with an increased risk of CVD compared to the reference level (ASCVD<7.5%) (all p-values <0.004; Fig 2). Conclusions: NAFLD and MAFLD perform equally in detecting CVD or its risk. The proposed change in terminology may not help to identify PWH requiring enhanced surveillance and preventative interventions for cardiovascular disease.

Non-alcoholic to metabolic associated fatty liver disease: Cardiovascular implications of a change in terminology in patients living with HIV / Raggi, Paolo; Milić, Jovana; Renzetti, Stefano; Motta, Federico; Gozzi, Licia; Cervo, Adriana; Burastero, Giulia; Iadisernia, Vittorio; Franceschi, Giacomo; Faltoni, Matteo; Mussini, Cristina; Sebastiani, Giada; Calza, Stefano; Guaraldi, Giovanni. - In: ATHEROSCLEROSIS. - ISSN 0021-9150. - 355:(2022), pp. 31-31. ((Intervento presentato al convegno 90th European Atherosclerosis Society Congress tenutosi a Milano nel May 22-25, 2022 [10.1016/j.atherosclerosis.2022.06.086].

Non-alcoholic to metabolic associated fatty liver disease: Cardiovascular implications of a change in terminology in patients living with HIV

Jovana Milić;Federico Motta;Licia Gozzi;Vittorio Iadisernia;Giacomo Franceschi;Matteo Faltoni;Cristina Mussini;Giovanni Guaraldi
2022

Abstract

Background and Aims: It has recently been suggested that the definition of non-alcoholic fatty liver disease (NAFLD) be changed to Metabolic Associated FLD (MAFLD) to better reflect the complex metabolic aspects of this syndrome. We compared the ability of MAFLD and NAFLD to correctly identify high CV risk patients, sub-clinical atherosclerosis or a history of prior CV events (CVEs) in patients living with HIV (PWH). Methods: Single center, cross-sectional study of PWH on stable anti-retrovirals. NAFLD was diagnosed by transient liver elastography; published criteria were used to diagnose MAFLD (JHepatol.2020;73(1):202-209). Four mutually exclusive groups were considered: low (<7.5%) vs high (>7.5%) ASCVD risk, subclinical CVD (carotid IMT ≥1 mm and/or coronary calcium score >100), and prior CVEs. The association of NAFLD and MAFLD with the CVD risk groups was explored via a multinominal model adjusted for age, sex, liver fibrosis, HIV duration, nadir CD4 and current CD4 cell count. Results: We included 1249 PWH (mean age 55 years, 74% men, median HIV duration 24 years). Prevalence of overweight/obesity and diabetes was 40% and 18%. Prevalence of NAFLD and MAFLD and overlapping groups are shown in Fig 1A. Fig 1B shows distribution of NAFLD/MAFLD in the 4 patient categories (p-for-trend <0.001). Both MAFLD and NAFLD were significantly associated with an increased risk of CVD compared to the reference level (ASCVD<7.5%) (all p-values <0.004; Fig 2). Conclusions: NAFLD and MAFLD perform equally in detecting CVD or its risk. The proposed change in terminology may not help to identify PWH requiring enhanced surveillance and preventative interventions for cardiovascular disease.
90th European Atherosclerosis Society Congress
Milano
May 22-25, 2022
Raggi, Paolo; Milić, Jovana; Renzetti, Stefano; Motta, Federico; Gozzi, Licia; Cervo, Adriana; Burastero, Giulia; Iadisernia, Vittorio; Franceschi, Giacomo; Faltoni, Matteo; Mussini, Cristina; Sebastiani, Giada; Calza, Stefano; Guaraldi, Giovanni
Non-alcoholic to metabolic associated fatty liver disease: Cardiovascular implications of a change in terminology in patients living with HIV / Raggi, Paolo; Milić, Jovana; Renzetti, Stefano; Motta, Federico; Gozzi, Licia; Cervo, Adriana; Burastero, Giulia; Iadisernia, Vittorio; Franceschi, Giacomo; Faltoni, Matteo; Mussini, Cristina; Sebastiani, Giada; Calza, Stefano; Guaraldi, Giovanni. - In: ATHEROSCLEROSIS. - ISSN 0021-9150. - 355:(2022), pp. 31-31. ((Intervento presentato al convegno 90th European Atherosclerosis Society Congress tenutosi a Milano nel May 22-25, 2022 [10.1016/j.atherosclerosis.2022.06.086].
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