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Fatty liver index and cardiovascular outcomes in never-treated hypertensive patients: a prospective cohort

Hypertension Research volume 46, pages 119–127 (2023)Cite this article

A Comment to this article was published on 06 December 2022

Abstract

The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing rapidly worldwide, affecting 25–30% of the population. Fatty liver index (FLI) is a validated marker of NAFLD and can be used as a screening tool for hepatic steatosis. The purpose of the study was to evaluate the relationship between FLI and the risk of major cardiovascular events in never treated hypertensive patients. We included 903 hypertensive patients without a history of cardiovascular disease (mean age 52.7 ± 11.4 years; men 55%; baseline clinic BP 149.8 ± 15.2/95.5 ± 10.1 mmHg). Participants were prospectively evaluated for a mean follow-up period of 5.2 ± 3.2 years with at least one annual visit. Patients were also categorized into two groups using an FLI of 60 units. The incidence of cardiovascular events during follow-up was 8.5% (n = 77). Patients with FLI < 60 (n = 625) had a better BP control compared to their counterparts with FLI ≥ 60 (n = 278) during follow up (43% vs 33%, p = 0.02). Cox-regression analysis indicated that FLI (Hazard Ratio [HR], 1.05; 95% Confidence Interval [CI], 1.03–1.07, p < 0.001), FLI z-scores (HR, 3.66; 95% CI, 2.22–6.04) and high-risk FLI (HR, 7.5; 95% CI, 3.12–18.04) were independent determinants of the outcome after adjustment for baseline and follow-up variables. Stratification by diabetes mellitus indicated that FLI predicted the outcome to a greater extent in those with than those without diabetes (P-interaction < 0.001). In conclusion, FLI has an independent prognostic value for the incidence of cardiovascular events in newly diagnosed, never-treated hypertensive patients. Therefore, FLI might identify higher-risk patients in the primary prevention of hypertension.

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Authors and Affiliations

  1. First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Eirini Siafi, Ioannis Andrikou, Dimitrios Konstantinidis, Niki Kakouri, Fotis Tatakis, Maria Kariori, Christina Filippou, Ioannis Zamanis, Eleni Manta, Sotirios Drogkaris, Ioannis Liatakis, Dimitrios Polyzos & Costas Tsioufis

  2. Department of Cardiology, Helena Venizelou Hospital, Athens, Greece

    Costas Thomopoulos

Authors
  1. Eirini Siafi
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  2. Ioannis Andrikou
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  3. Costas Thomopoulos
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  4. Dimitrios Konstantinidis
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  5. Niki Kakouri
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  14. Costas Tsioufis
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Contributions

ES, CTh, CTs, DK, and IA, contributed to the conception or the design of the present work. ES, NK, FT, MK, CF, IZ, EM, SD, IL, and SP contributed to the data acquisition. ES, CTh, CTs, and IA, contributed to data analysis and interpretation of the results. ES and CTh, drafted the first version of the manuscript. CTh and CTs. critically revised the manuscript. All authors gave final approval and agreed to be accountable for all aspects of the work, ensuring integrity and accuracy.

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Correspondence to Costas Thomopoulos.

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Conflict of interest

CTh reports honoraria for lectures or consultancy fees from Menarini, Medtronic, Berlin-Chemie, Sanofi, and AstraZeneca. CTs, reports honoraria for advisory boards and lectures from Medtronic, Servier, Bayer, Menarini, Novartis, AstraZeneca, Boehringer, Pfizer, Pythagoras, Sanofi, and Amgen. All other authors report no conflict. However, all authors have not received any funding directly related to the subject or content of this work.

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Siafi, E., Andrikou, I., Thomopoulos, C. et al. Fatty liver index and cardiovascular outcomes in never-treated hypertensive patients: a prospective cohort. Hypertens Res 46, 119–127 (2023). https://doi.org/10.1038/s41440-022-01015-x

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