Clinical assessment for high-risk patients with non-alcoholic fatty liver disease in primary care and diabetology practices

2020 ◽  
Vol 52 (3) ◽  
pp. 513-526 ◽  
Author(s):  
Zobair M. Younossi ◽  
Kathleen E. Corey ◽  
Naim Alkhouri ◽  
Mazen Noureddin ◽  
Ira Jacobson ◽  
...  
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
High Risk ◽  
Fatty Liver ◽  
Clinical Assessment ◽  
Fatty Liver Disease ◽  
Alcoholic Fatty Liver ◽  
High Risk Patients ◽  
Risk Patients ◽  
Alcoholic Fatty Liver Disease

Have we learnt all from Improve-It? Part I. Core results and subanalyses on the effects of ezetimibe added to statin therapy related to age, gender and selected chronic diseases (kidney disease, diabetes mellitus and non- alcoholic fatty liver disease)

2020 ◽  
Vol 18 ◽  
Author(s):  
Zlatko Fras ◽  
Dimitri P. Mikhailidis
Keyword(s):  
Diabetes Mellitus ◽  
Liver Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Alcoholic Fatty Liver ◽  
Risk Patients ◽  
Very High ◽  
Alcoholic Fatty Liver Disease

: IMPROVE-IT (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial) was a randomized clini- cal trial (18,144 patients) that evaluated the efficacy of the combination of ezetimibe with simvastatin vs simvastatin mono- therapy in patients with acute coronary syndrome (ACS) and moderately increased low-density lipoprotein cholesterol (LDL-C) levels (of up to 2.6-3.2 mmol/L; 100-120 mg/dL). After 7 years of follow-up, combination therapy resulted in an additional LDL-C decrease [1.8 mmol/L, or 70 mg/dL, within the simvastatin (40 mg/day) monotherapy arm and 1.4 mmol/L, or 53 mg/dL for simvastatin (40 mg/day) + ezetimibe (10 mg/day)] and showed an incremental clinical benefit (composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary re- vascularization (≥30 days after randomization), or nonfatal stroke; hazard ratio (HR) of 0.936, and 95% CI 0.887-0.996, p=0.016). Therefore, for very high cardiovascular risk patients “even lower is even better” regarding LDL-C, independently of the LDL-C reducing strategy. These findings confirm ezetimibe as an option to treat very-high-risk patients who cannot achieve LDL-C targets with statin monotherapy. Additional analyses of the IMPROVE-IT (both prespecified and post-hoc) include specific very-high-risk subgroups of patients (those with previous acute events and/or coronary revascularization, older than 75 years, as well as patients with diabetes mellitus, chronic kidney disease or non-alcoholic fatty liver disease). The data from IMPROVE-IT also provide reassurance regarding longer-term safety and efficacy of the intensification of li- pid-lowering therapy in very-high-risk patients resulting in very low LDL-C levels. We comment on the results of several (sub) analyses of IMPROVE-IT.

scholarly journals Screening for undiagnosed non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH): A population-based risk factor assessment using vibration controlled transient elastography (VCTE)

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260320
Author(s):  
Wayne Eskridge ◽  
John M. Vierling ◽  
Wayne Gosbee ◽  
Gabriella A. Wan ◽  
May-Linh Hyunh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Disease ◽  
High Risk ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Transient Elastography ◽  
Population Based ◽  
Alcoholic Fatty Liver ◽  
Risk Patients ◽  
Alcoholic Fatty Liver Disease

The screening for undiagnosed non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (SUNN) study was a population-based screening study that aimed to provide proof of concept to encourage community-level screening and detection for this non-communicable disease. Current screening guidelines do not recommend the routine screening of nonalcoholic fatty liver disease (NAFLD) for asymptomatic populations, so providers are not encouraged to actively seek disease, even in high-risk patients. This study sought to determine whether a self-selecting cohort of asymptomatic individuals would have scores based on vibration controlled transient elastography (VCTE) and controlled attenuation parameter (CAP) significantly correlated to risk factors to suggest that routine screening for high-risk patients should be recommended. The study recruited 1,070 self-selected participants in Houston and Galveston County, Texas, 940 of which were included in final analysis. A pre-screening survey was used to determine eligibility. VCTE-based scores analyzed steatosis and fibrosis levels. Fifty-seven percent of the study population demonstrated steatosis without fibrosis, suggesting NAFLD, while 16% demonstrated both steatosis and fibrosis, suggesting NASH. Statistically significant risk factors included factors related to metabolic syndrome, race, and age, while statistically significant protective factors included consumption of certain foods and exercise. The findings of this study suggest that high-risk individuals should be screened for NAFLD even in the absence of symptoms and that community-based screenings are an effective tool, particularly in the absence of proactive guidelines for providers.

Non-alcoholic fatty liver disease: a survey of involvement of primary care physicians

2020 ◽  
Vol 65 (4) ◽  
Author(s):  
Amir Mari ◽  
Sohaib Omari ◽  
Fadi Abu Baker ◽  
Saif Abu Much ◽  
Helal Said Ahmad ◽  
...  
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Fatty Liver ◽  
Primary Care Physicians ◽  
Fatty Liver Disease ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

scholarly journals Epidemiological modifiers of non-alcoholic fatty liver disease: Focus on high-risk groups

2015 ◽  
Vol 47 (12) ◽  
pp. 997-1006 ◽  
Author(s):  
Amedeo Lonardo ◽  
Stefano Bellentani ◽  
Curtis K. Argo ◽  
Stefano Ballestri ◽  
Christopher D. Byrne ◽  
...  
Keyword(s):  
Liver Disease ◽  
High Risk ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Risk Groups ◽  
Alcoholic Fatty Liver ◽  
Disease Focus ◽  
Alcoholic Fatty Liver Disease

scholarly journals Clinical assessment and management of liver fibrosis in non-alcoholic fatty liver disease

2020 ◽  
Vol 26 (39) ◽  
pp. 5919-5943
Author(s):  
Alejandro Campos-Murguía ◽  
Astrid Ruiz-Margáin ◽  
José A González-Regueiro ◽  
Ricardo U Macías-Rodríguez
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Fatty Liver ◽  
Clinical Assessment ◽  
Fatty Liver Disease ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

scholarly journals Cardiovascular involvement after liver transplantation: role of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis

2021 ◽  
Author(s):  
Rosa Lombardi ◽  
Giuseppina Pisano ◽  
Silvia Fargion ◽  
Anna Ludovica Fracanzani
Keyword(s):  
Metabolic Syndrome ◽  
Liver Transplantation ◽  
Liver Disease ◽  
High Risk ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

Patients submitted to liver transplantation (LT) are exposed to high risk of cardiovascular (CV) complications which are the main determinants of both short-term and long-term morbidity and mortality in LT. Non-alcoholic fatty liver disease (NAFLD) is a very frequent condition in general population and is associated with a high risk of cardiovascular disease (CVD) which represents the first cause of death of these patients. NAFLD is predicted to become the first indication to LT and nowadays is also frequently detected in patients submitted to LT for other indications. Thus, the risk of CVD in patients submitted to LT is forecasted to increase in the next years. In this review the extent of CV involvement in patients submitted to LT and the role of NAFLD, either recurring after transplantation or as de novo presentation, in increasing CV risk is analysed. The risk of developing metabolic alterations, including diabetes, hypertension, dyslipidemia and weight gain, all manifestations of metabolic syndrome, occurring in the first months after LT, is depicted. The different presentations of cardiac involvement, represented by early atherosclerosis, coronary artery disease, heart failure and arrhythmias in patients with NAFLD submitted to LT is described. In addition, the tools to detect cardiac alterations either before or after LT is reported providing the possibility for an early diagnosis of CVD and an early therapy able to reduce morbidity and mortality for these diseases. The need for long-term concerted multidisciplinary activity with dietary counseling and exercise combined with drug treatment of all manifestations of metabolic syndrome is emphasized.

scholarly journals Sirtuin3 rs28365927 functional variant confers to the high risk of non-alcoholic fatty liver disease in Chinese Han population

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Li-jie Chen ◽  
Jing Guo ◽  
Song-xia Zhang ◽  
Ying Xu ◽  
Qing Zhao ◽  
...  
Keyword(s):  
Liver Disease ◽  
High Risk ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Chinese Han Population ◽  
Chinese Han ◽  
Alcoholic Fatty Liver ◽  
Han Population ◽  
Functional Variant ◽  
Alcoholic Fatty Liver Disease

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is a multifactorial condition associated with aging, insulin resistance, metabolic syndrome, genetic factors and more. Although genetic traits are among the most important risks factors for NAFLD, the understanding of their influence is still quite limited. The present study aimed at identifying novel single nucleotide polymorphisms (SNPs) that may confer a risk for NAFLD in the Han Chinese population. Methods Based on the “two-hit hypothesis”, candidate SNPs, including Sirtuin3 rs28365927, were genotyped by MassARRAY in B-type ultrasonography-proven NAFLD patients (n = 292) and healthy controls (n = 387). Results In a model analysis of individuals matched based on gender and age that compared 223 NAFLD and 223 non-NAFLD patients, the rs28365927 GA + AA genotype was a significant risk factor for the development of NAFLD in a dominant model. Rs28365927 was significantly associated with a higher NAFLD risk in both an additive model (A vs G) and genotypic model (GA vs GG). Among the NAFLD patients, serum levels of total bilirubin (TBIL), DBIL direct bilirubin (DBIL) and glutamic-pyruvic transaminase (ALT) in rs28365927 A allele carriers (GA + AA) were 11.1, 14.7 and 41.5% higher, respectively, than in non-carriers (GG). Furthermore, among the NAFLD patients, the carriers of Rs28365927 allele A were positively correlated with higher ALT levels. Conclusion Sirtuin3 rs28365927 functional variant confers to the high risk of non-alcoholic fatty liver disease in Chinese Han population. The rs28365927 A allele significantly increased the ALT levels of NAFLD patients.

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