PMID- 38350680 OWN - NLM STAT- MEDLINE DCOM- 20240215 LR - 20240227 IS - 1756-1833 (Electronic) IS - 0959-8138 (Print) IS - 0959-8138 (Linking) VI - 384 DP - 2024 Feb 13 TI - Association of non-alcoholic fatty liver disease with cardiovascular disease and all cause death in patients with type 2 diabetes mellitus: nationwide population based study. PG - e076388 LID - 10.1136/bmj-2023-076388 [doi] LID - e076388 AB - OBJECTIVE: To investigate the risk of non-alcoholic fatty liver disease (NAFLD) for cardiovascular disease and all cause death in patients with type 2 diabetes mellitus (T2DM). DESIGN: Nationwide population based study. SETTING: Longitudinal cohort study in Korea. PARTICIPANTS: 7 796 763 participants in the National Health Screening Programme in 2009 were divided into three groups based on NAFLD status: no NAFLD (fatty liver index<30); grade 1 NAFLD (30/=60). Median follow-up was 8.13 years. MAIN OUTCOME MEASURES: The primary outcome was incident cardiovascular disease (myocardial infarction, ischaemic stroke) or all cause death. RESULTS: Of 7 796 763 participants, 6.49% (n=505 763) had T2DM. More patients with T2DM had grade 1 NAFLD (34.06%) and grade 2 NAFLD (26.73%) than those without T2DM (grade 1 NAFLD: 21.20%; grade 2 NAFLD: 10.02%). The incidence rate (per 1000 person years) of cardiovascular disease and all cause death increased in the order of no NAFLD, grade 1 NAFLD, and grade 2 NAFLD, and the incidence rates in patients with T2DM were higher than those in patients without T2DM. The five year absolute risk for cardiovascular disease and all cause death increased in the order of no NAFLD, grade 1 NAFLD, and grade 2 NAFLD in patients without and with T2DM (no NAFLD, without T2DM: 1.03, 95% confidence interval 1.02 to 1.04, and 1.25, 1.24 to 1.26, respectively; grade 1 NAFLD, without T2DM: 1.23, 1.22 to 1.25, and 1.50, 1.48 to 1.51, respectively; grade 2 NAFLD, without T2DM: 1.42, 1.40 to 1.45, and 2.09, 2.06 to 2.12, respectively; no NAFLD, with T2DM: 3.34, 3.27 to 3.41, and 3.68, 3.61 to 3.74, respectively; grade 1 NAFLD, with T2DM: 3.94, 3.87 to 4.02, and 4.25, 4.18 to 4.33, respectively; grade 2 NAFLD, with T2DM: 4.66, 4.54 to 4.78, and 5.91, 5.78 to 6.05, respectively). Patients with T2DM and without NAFLD had a higher five year absolute risk for cardiovascular disease and all cause death than those without T2DM and with grade 2 NAFLD. Risk differences for cardiovascular disease and all cause death between no NAFLD and grade 1 or grade 2 NAFLD were higher in patients with T2DM than in those without T2DM. CONCLUSIONS: NAFLD in patients with T2DM seems to be associated with a higher risk of cardiovascular disease and all cause death, even in patients with mild NAFLD. Risk differences for cardiovascular disease and all cause death between the no NAFLD group and the grade 1 or grade 2 NAFLD groups were higher in patients with T2DM than in those without T2DM. CI - (c) Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Kim, Kyung-Soo AU - Kim KS AUID- ORCID: 0000-0002-7738-2284 AD - Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea. FAU - Hong, Sangmo AU - Hong S AUID- ORCID: 0000-0002-8535-0565 AD - Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea. FAU - Han, Kyungdo AU - Han K AUID- ORCID: 0000-0002-6096-1263 AD - Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea. FAU - Park, Cheol-Young AU - Park CY AUID- ORCID: 0000-0002-9415-9965 AD - Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. LA - eng PT - Journal Article DEP - 20240213 PL - England TA - BMJ JT - BMJ (Clinical research ed.) JID - 8900488 SB - IM CIN - BMJ. 2024 Feb 13;384:q309. PMID: 38350679 MH - Humans MH - *Non-alcoholic Fatty Liver Disease/complications/epidemiology/diagnosis MH - *Diabetes Mellitus, Type 2/complications/epidemiology/diagnosis MH - Risk Factors MH - *Cardiovascular Diseases/epidemiology/complications MH - Longitudinal Studies MH - *Brain Ischemia/complications MH - *Stroke/complications PMC - PMC10862140 COIS- Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. EDAT- 2024/02/14 00:44 MHDA- 2024/02/15 06:43 PMCR- 2024/02/13 CRDT- 2024/02/13 20:53 PHST- 2024/02/15 06:43 [medline] PHST- 2024/02/14 00:44 [pubmed] PHST- 2024/02/13 20:53 [entrez] PHST- 2024/02/13 00:00 [pmc-release] AID - bmj-2023-076388.R2 [pii] AID - kimk076388 [pii] AID - 10.1136/bmj-2023-076388 [doi] PST - epublish SO - BMJ. 2024 Feb 13;384:e076388. doi: 10.1136/bmj-2023-076388.