Cardiovascular (CV) disease is the leading cause of mortality in patients with nonalcoholic fatty liver disease (NAFLD). Nevertheless, it has been found that female sex is protective against CV disease such as myocardial infarction, angina, and stroke. The goal of the current study is to evaluate whether female sex remains a protective factor against CV disease in NAFLD.

The authors of the study recognized all adults diagnosed with NAFLD, between 1997 and 2014 and included an age- and sex-matched (1:4) referent cohort from the general population. NAFLD was determined using a code-based algorithm with high validity tested by medical record review. The effect of female sex on the incidence of CV events was analyzed using Cox proportional hazards regression analysis stratified by standard clinical risk factors.

The outcome of the study included a total of 3,869 patients with NAFLD and 15,209 age- and sex-matched controls subjects. A total of 3,851 CV events were estimated after a median follow-up time of 7 years. Although female sex was found to be protective for ischemic CV events in the general population (hazard ratio = 0.71, 95% confidence interval 0.62-0.80), the effect was remarkably reduced among those with NAFLD (hazard ratio = 0.90, 95% confidence interval 0.74-1.08), even after stratification by time-dependent CV risk factors and control for diagnostic testing during routine medical examinations. Excess CV events were higher in women than in men (18% vs 9%) and were associated with higher rate of mortality (9% vs 6%) among patients with NAFLD.

Thus, women with NAFLD do not possess protection against CV events, which is usually exhibited by female sex. Moreover, the increased risk of these cardiac incidents in women with NAFLD is often underestimated by current diagnostic methods in clinical practice.

Source: Women With Nonalcoholic Fatty Liver Disease Lose Protection Against Cardiovascular Disease: A Longitudinal Cohort Study. Am J Gastroenterol. 2019 Nov;114(11):1764-1771.