Associations of the fatty liver and hepatic steatosis indices with risk of cardiovascular disease: Interrelationship with age

Background The fatty liver index (FLI) and the hepatic steatosis index (HSI), are biomarker-based algorithms developed as proxies for non-alcoholic fatty liver disease (NAFLD). We assessed associations of FLI and HSI with cardiovascular disease (CVD) risk. Materials and methods The FLI and HSI were estimated at baseline in the PREVEND cohort involving 6340 participants aged 28–75 years without pre-existing CVD. Results During a median follow-up of 10.5 years, 631 CVD events occurred. In age-and sex-adjusted analysis, the hazard ratio (HR) (95% CI) for CVD comparing FLI ≥ 60 versus FLI < 30 was 1.53 (1.25–1.88); which was attenuated to 0.89 (0.70–1.13) on adjustment for conventional cardiovascular risk factors. The association remained absent after additional adjustment for potential confounders 0.85 (0.65–1.11). Comparing HSI > 36 versus HSI < 30, the corresponding adjusted HRs were 1.29 (1.02–1.65), 0.84 (0.65–1.09) and 0.79 (0.55–1.13) respectively. Subgroup analyses suggested a positive association in younger participants (< 50 years) for FLI and inverse associations in older participants (≥ 50 years) for both indices (P for interaction for all = 0.001). Conclusion Current data suggest age interactions in the association of NAFLD (as assessed by FLI or HSI) with CVD risk in a general Caucasian population.