Nonalcoholic Fatty Liver Disease Is Independently Associated With an Increased Incidence of Cardiovascular Events in Type 2 Diabetic Patients

Recent data suggest that the presence of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes may be linked to increased cardiovascular disease (CVD) independent of components of the metabolic syndrome (1–3), although this hypothesis needs verification in larger studies. We assessed whether NAFLD, as diagnosed by ultrasound, predicts the risk of incident CVD events in a large cohort of type 2 diabetic adults. Study subjects were participants in the Valpolicella Heart Diabetes Study (1). Briefly, we enrolled all of the type 2 diabetic outpatients ( n = 2,103) who regularly attended our clinic in the period January–December 2000 after excluding those who had manifest CVD and/or secondary causes of chronic liver disease (alcohol abuse, viral infection, or medications). The local ethics committee approved the study. All participants provided written informed consent. During 6.5 years of follow-up (through December 2006; follow-up range: 5–84 months), 384 participants subsequently developed CVD events (myocardial infarction, ischemic stroke, coronary revascularization, or cardiovascular death), whereas 1,719 patients remained free of diagnosed CVD. These events were ascertained by patient history, chart review, autopsy reports, and family contact (1). Plasma liver enzymes, A1C, and other biochemical blood measurements were determined by standard procedures. At baseline, most participants (∼86%) had normal liver enzymes (reference ranges for aminotransferases were 10–35 and 10–50 units/l for female and male subjects, respectively) and were abstainers (77%) or drank minimally (13%); only 10% of participants …