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A Meta-Analysis on the Global Prevalence, Risk factors and Screening of Coronary Heart Disease in Non-alcoholic Fatty Liver Disease
Clinical Gastroenterology and Hepatology  (IF11.382),  Pub Date : 2021-09-22, DOI: 10.1016/j.cgh.2021.09.021
Jonathan Zhi Kai Toh, Xin-Hui Pan, Phoebe Wen Lin Tay, Cheng Han Ng, Jie Ning Yong, Jieling Xiao, Jin Hean Koh, En Ying Tan, Eunice Xiang Xuan Tan, Yock Young Dan, Poay Huan Loh, Roger Foo, Nicholas WS. Chew, Arun J. Sanyal, Mark D. Muthiah, Mohammad Shadab Siddiqui

Background and Aims

Cardiovascular disease remains the leading cause of death in patients with non-alcoholic fatty liver disease (NAFLD). Studies examining the association of coronary heart disease (CHD) and NAFLD are cofounded by various cardiometabolic factors particularly diabetes and body mass index. Hence, we seek to explore such association by investigating the global prevalence, independent risk factors and influence of steatosis grade on manifestation of CHD among patients with NAFLD.


Two databases, Embase and Medline, were utilised to search for articles relating to NAFLD and CHD. Data including but not limited to continent, diagnostic methods, baseline characteristics, prevalence of CHD, CHD severity, NAFLD severity, and risk factors were extracted.


Of the 38 articles included, 14 reported prevalence of clinical coronary artery disease (CAD) and 24 subclinical CAD. The pooled prevalence of CHD was 44.6% (CI: 36.0% - 53.6%) among 67,070 NAFLD patients with an odds ratio of 1.33 (CI: 1.21% - 1.45%, p<0.0001). The prevalence of CHD was higher in patients with moderate to severe steatosis (37.5%, CI: 15.0% - 67.2%) than those with mild steatosis (29.6%, CI: 13.1% - 54.0%). The pooled prevalence of subclinical and clinical CAD was 38.7% (CI: 29.8% - 48.5%) and 55.4% (CI: 39.6% - 70.1%) respectively.


Steatosis was found to be related with CHD involvement, with moderate to severe steatosis related to clinical CAD. Early screening and prompt intervention for CHD in NAFLD are warranted for holistic care in NAFLD.