Acute Coronary Syndromes and Nonalcoholic Fatty Liver Disease: “Un Affaire de Coeur”

Table 3

Evidence evaluating the association between ACS and NAFLD.

Condition	Country	Study population	Evidence of association	Observation
Acute myocardial infarction	USA [34]	2,343	Lack of association	Demonstrating a lack of significant association in type 2 diabetic patients only.
	Netherlands, Spain, and UK [42]	17.7 million	Weak	Significant association after adjustment for age and smoking. However, the significance was lost after adjusting for systolic blood pressure, type 2 diabetes, total cholesterol level, statin use, and hypertension.
	Turkey [38]	224	Strong	NAFLD was more frequent in MI patients.
	Korea [43]	3,011,588	Strong	FLI significantly associated with MI even after performing stratified analyses by body weight, cholesterol, age, sex, use of dyslipidemia medication, obesity, diabetes, and hypertension.
	Germany [44]	44,096	Strong	Significant association even after performing regression analysis.
	Korea [46]	111,492	Strong	Significant association even after performing adjustments for age, sex, year of visit, smoking status, alcohol intake, BMI, systolic blood pressure, fasting glucose, LDL cholesterol, use of antihypertensive medications, use of antidiabetic medications, use of lipid-lowering medications, and use of aspirin and antithrombotic medications at baseline.
	USA [47]	13,290	Strong	NAFLD subtypes 2 and 5 were independently significantly associated with MI.
STEMI	Finland [41]	1,205	Weak	FLI is associated with MI in minimally adjusted models. However, it lost significance in most comprehensive models with metabolic factors.
	Italy [33]	95	Strong	High prevalence of NAFLD in nondiabetic patients admitted for STEMI.
	Turkey [36]	186	Strong	Severe FLD is an independent predictor of STEMI by performing multivariate analysis.
ACS	Canada [45]	139	Strong	60.5% of severe CAD patients had NAFLD.

ACS: acute coronary syndrome; FLD: fatty liver disease; FLI: Fatty Liver Index; LDL: low-density lipoproteins; MI: myocardial infarction; NAFLD: nonalcoholic fatty liver disease; and STEMI: ST-segment elevation myocardial infarction.