Prevalence and Prediction of Coronary Artery Disease in Patients With Liver Cirrhosis: A Registry-Based Matched Case Control Study

Study Questions:

What is the prevalence of coronary artery disease (CAD) by coronary computed tomography (CT) angiography in asymptomatic patients with liver cirrhosis (LC)?

Methods:

This was a registry-based retrospective cohort study conducted with 1,045 consecutive prospectively registered patients who underwent computerized angiography as part of a pre-liver transplant (LT) cardiac workup. These patients were matched with 6,283 controls with no liver disease and based on propensity scores according to established cardiovascular risk factors. These control subjects underwent coronary CT scanning as part of a comprehensive health evaluation at the institution’s health promotion center. Obstructive CAD was defined as 50% or more luminal narrowing in any artery.

Results:

Propensity-score matched analyses demonstrated that the frequency of obstructive CAD was similar in the patients with cirrhosis, compared to controls; however, cirrhotics had a significantly greater prevalence of nonobstructive CAD (7.2% vs. 7.9%; p = 0.646; and 30.6% vs. 23.4%; p = 0.001, respectively). In the cohort of cirrhotic patients, the following were independently associated with obstructive CAD: older age, male gender, hypertension, diabetes, and alcoholic cirrhosis.

Conclusions:

Although asymptomatic patients with cirrhosis had a prevalence of occult obstructive CAD similar to that of matched controls, there was a significantly increased prevalence of nonobstructive CAD in cirrhotics, compared to controls.

Perspective:

There is controversy on whether cirrhosis protects against or accelerates atherosclerosis. This is an important study, which establishes that there is no difference in prevalence of obstructive CAD in cirrhotics, compared with controls. However, there is an increased prevalence of nonobstructive CAD in patients with cirrhosis, lending support to a strategy of cardiac evaluation in the presurgical period for patients with cirrhosis. While the optimal means for assessing cardiovascular risk in cirrhotics has not been established, the present study would suggest the importance of control of traditional risk factors.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging, Hypertension

Keywords: Prevalence, Coronary Artery Disease, Atherosclerosis, Liver Transplantation, Coronary Angiography, Risk Factors, Hypertension, Diabetes Mellitus


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