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Sarcopenia modifies the associations of nonalcoholic fatty liver disease with all-cause and cardiovascular mortality among older adults.

ABSTRACT: The contribution of nonalcoholic fatty liver disease (NAFLD) to all-cause and cardiovascular mortality remains controversial. Sarcopenia, a measure of muscle mass, strength and function, may identify which persons are most at risk for adverse effects of NAFLD. We aimed to test the hypothesis that sarcopenia modifies the associations between NAFLD and all-cause and cardiovascular mortality. A total of 2446 older adults (≥ 60 years) from the third National Health and Nutrition Examination Survey were enrolled. Their mortality data were linked to death certificates in the National Death Index. Sarcopenia was defined as having low skeletal muscle mass together with slow gait speed, which captures both muscle mass and muscle function. Ultrasound tests were used for the assessment of hepatic steatosis. During follow-up (median 16.8 years), 1530 older subjects died from any cause, of which 379 were cardiovascular-related. All-cause and cardiovascular mortality rates were 4.31 and 1.07 per 100 person-years, respectively. In a multivariate model, using participants without NAFLD and sarcopenia as the reference group, individuals with both NAFLD and sarcopenia had 1.69 times [95% confidence interval (CI) 1.23-2.31] and 2.17 times (95% CI 1.33-3.54) higher risks of all-cause and cardiovascular mortality, respectively. However, NAFLD persons without sarcopenia had hazard ratios for all-cause and cardiovascular mortality similar to those of the reference group. Sarcopenia modified the associations of NAFLD with all-cause and cardiovascular mortality. Sarcopenia may identify older adults who are at the highest risk for adverse outcomes associated with NAFLD.

SUBMITTER: Sun X

PROVIDER: S-EPMC8329219 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundBlood pressure (BP) management in frail older people is challenging. An randomised controlled trial of largely non-frail older people found cardiovascular and mortality benefit with systolic (S) BP target <120 mmHg. However, all-cause mortality by attained BP in routine care in frail adults aged above 75 is unclear.ObjectivesTo estimate observational associations between baseline BP and mortality/cardiovascular outcomes in a primary-care population aged above 75, stratified by frailty.MethodsProspective observational analysis using electronic health records (clinical practice research datalink, n = 415,980). We tested BP associations with cardiovascular events and mortality using competing and Cox proportional-hazards models respectively (follow-up ≤10 years), stratified by baseline electronic frailty index (eFI: fit (non-frail), mild, moderate, severe frailty), with sensitivity analyses on co-morbidity, cardiovascular risk and BP trajectory.ResultsRisks of cardiovascular outcomes increased with SBPs >150 mmHg. Associations with mortality varied between non-frail <85 and frail 75-84-year-olds and all above 85 years. SBPs above the 130-139-mmHg reference were associated with lower mortality risk, particularly in moderate to severe frailty or above 85 years (e.g. 75-84 years: 150-159 mmHg Hazard Ratio (HR) mortality compared to 130-139: non-frail HR = 0.94, 0.92-0.97; moderate/severe frailty HR = 0.84, 0.77-0.92). SBP <130 mmHg and Diastolic(D)BP <80 mmHg were consistently associated with excess mortality, independent of BP trajectory toward the end of life.ConclusionsIn representative primary-care patients aged ≥75, BP <130/80 was associated with excess mortality. Hypertension was not associated with increased mortality at ages above 85 or at ages 75-84 with moderate/severe frailty, perhaps due to complexities of co-existing morbidities. The priority given to aggressive BP reduction in frail older people requires further evaluation.

Project description:ImportanceBariatric surgery (BS) is associated with significantly reduced incidence of cardiovascular diseases and mortality in patients with obesity. However, whether BS can decrease major adverse cardiovascular events in patients with nonalcoholic fatty liver disease (NAFLD) remains poorly understood.ObjectiveTo investigate the association of BS with the incidence of adverse cardiovascular events and all-cause mortality in patients with NAFLD and obesity.Design, setting, and participantsThis was a large, population-based, retrospective cohort using data from the TriNetX platform. Adult patients with a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 35 or greater and NAFLD (without cirrhosis) who underwent BS between January 1, 2005, and December 31, 2021, were included. Patients in the BS group were matched with patients who did not undergo surgery (non-BS group) according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. Patient follow-up ended on August 31, 2022, and data were analyzed in September 2022.ExposuresBariatric surgery vs nonsurgical care.Main outcomes and measuresThe primary outcomes were defined as the first incidence of new-onset heart failure (HF), composite cardiovascular events (unstable angina, myocardial infarction, or revascularization, including percutaneous coronary intervention or coronary artery bypass graft), composite cerebrovascular disease (ischemic or hemorrhagic stroke, cerebral infarction, transient ischemic attack, carotid intervention, or surgery), and a composite of coronary artery procedures or surgeries (coronary stenting, percutaneous coronary intervention, or coronary artery bypass). Cox proportional hazards models were used to estimate hazard ratios (HRs).ResultsOf 152 394 eligible adults, 4693 individuals underwent BS; 4687 patients who underwent BS (mean [SD] age, 44.8 [11.6] years; 3822 [81.5%] female) were matched with 4687 individuals (mean [SD] age, 44.7 [13.2] years; 3883 [82.8%] years) who did not undergo BS. The BS group had significantly lower risk of new-onset of HF (HR, 0.60; 95% CI, 0.51-0.70), cardiovascular events (HR, 0.53; 95% CI, 0.44-0.65), cerebrovascular events (HR, 0.59; 95% CI, 0.51-0.69), and coronary artery interventions (HR, 0.47; 95% CI, 0.35-0.63) compared with the non-BS group. Similarly, all-cause mortality was substantially lower in the BS group (HR, 0.56; 95% CI, 0.42-0.74). These outcomes were consistent at follow-up duration of 1, 3, 5, and 7 years.Conclusions and relevanceThese findings suggest that BS was significantly associated with lower risk of major adverse cardiovascular events and all-cause mortality in patients with NAFLD and obesity.

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Sarcopenia modifies the associations of nonalcoholic fatty liver disease with all-cause and cardiovascular mortality among older adults.

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