{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T15:59:11Z","timestamp":1790351951319,"version":"4.1.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,26]],"date-time":"2021-07-26T00:00:00Z","timestamp":1627257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Cardiovascular disease (CVD) risk is higher in patients with nonalcoholic fatty liver disease (NAFLD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate whether this can be attributed to the link between NAFLD and known CVD risk factors or to an independent contribution of liver steatosis and fibrosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is an analysis of data from the 2017-2018 cycle of the National Health and Nutrition Examination Survey. We included participants older than 40 years with available data on vibration-controlled transient elastography (VCTE) and without viral hepatitis and significant alcohol consumption. Steatosis and fibrosis were diagnosed by the median value of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively. History of CVD was self-reported and defined as a composite of coronary artery disease and stroke\/transient ischemic attacks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 2734 included participants, prevalence of NAFLD was 48.6% (95% CI 45.1-51.4), 316 participants (9.7%, 95% CI 8.1-11.6) had evidence of significant liver fibrosis and 371 (11.5%, 95% CI 9.5-13.9) had a history of CVD. In univariate analysis, patients with CVD had a higher prevalence of steatosis (59.6% <jats:italic>vs<\/jats:italic> 47.1%, p=0.013), but not fibrosis (12.9% <jats:italic>vs<\/jats:italic> 9.3%, p=0.123). After adjustment for potential confounders in a multivariable logistic regression model, neither steatosis nor significant fibrosis were independently associated with CVD and heart failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this population-based study, we did not identify an independent association between steatosis and fibrosis and CVD. Large prospective cohort studies are needed to provide a more definitive evidence on this topic.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2021.711484","type":"journal-article","created":{"date-parts":[[2021,7,26]],"date-time":"2021-07-26T12:15:58Z","timestamp":1627301758000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":28,"title":["Nonalcoholic Fatty Liver Disease, Liver Fibrosis and Cardiovascular Disease in the Adult US Population"],"prefix":"10.3389","volume":"12","author":[{"given":"Stefano","family":"Ciardullo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Cannistraci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Mazzetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Mortara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Perseghin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31173","article-title":"Changes in the Global Burden of Chronic Liver Diseases From 2012 to 2017: The Growing Impact of NAFLD","volume":"72","author":"Paik","year":"2020","journal-title":"Hepatology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global Epidemiology of Nonalcoholic Fatty Liver Disease-Meta-Analytic Assessment of Prevalence, Incidence, and Outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology"},{"key":"B3","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1016\/j.cgh.2020.06.048","article-title":"Prevalence of Liver Steatosis and Fibrosis Detected by Transient Elastography in Adolescents in the 2017\u20132018 National Health and Nutrition Examination Survey","volume":"19","author":"Ciardullo","year":"2021","journal-title":"Clin Gastroenterol Hepatol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.1999.01377.x","article-title":"Nonalcoholic Steatohepatitis: A Proposal for Grading and Staging the Histological Lesions","volume":"94","author":"Brunt","year":"1999","journal-title":"Am J Gastroenterol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.15220","article-title":"Nonalcoholic Fatty Liver Disease and Advanced Fibrosis in US Adults Across Blood Pressure Categories","volume":"76","author":"Ciardullo","year":"2020","journal-title":"Hypertension"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-1778","article-title":"High Prevalence of Advanced Liver Fibrosis Assessed by Transient Elastography Among U.S. Adults With Type 2 Diabetes","volume":"44","author":"Ciardullo","year":"2021","journal-title":"Diabetes Care"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(99)00271-5","article-title":"Association of Nonalcoholic Fatty Liver Disease With Insulin Resistance","volume":"107","author":"Marchesini","year":"1999","journal-title":"Am J Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0912063","article-title":"Risk of Cardiovascular Disease in Patients With Nonalcoholic Fatty Liver Disease","volume":"363","author":"Targher","year":"2010","journal-title":"N Engl J Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"l5367","DOI":"10.1136\/bmj.l5367","article-title":"Non-Alcoholic Fatty Liver Disease and Risk of Incident Acute Myocardial Infarction and Stroke: Findings From Matched Cohort Study of 18 Million European Adults","volume":"367","author":"Alexander","year":"2019","journal-title":"BMJ"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31608","article-title":"Hepatic Fibrosis Associates With Multiple Cardiometabolic Disease Risk Factors: The Framingham Heart Study","volume":"73","author":"Long","year":"2021","journal-title":"Hepatology"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1053\/j.gastro.2018.12.036","article-title":"Noninvasive Assessment of Liver Disease in Patients With Nonalcoholic Fatty Liver Disease","volume":"156","author":"Castera","year":"2019","journal-title":"Gastroenterology"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2020.100219","article-title":"Case-Finding Strategies in non-Alcoholic Fatty Liver Disease","volume":"3","author":"Boursier","year":"2021","journal-title":"JHEP Rep"},{"key":"B13","unstructured":"U.S. Department of Health and Human Services2017: National Health and Nutrition Examination Survey (NHANES)2017"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-S002","article-title":"2. 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