Table1_Predictive value of the Framingham steatosis index for cardiovascular risk: a nationwide population-based cohort study.docx

BackgroundNon-alcoholic fatty liver disease (NAFLD) is common and is associated with cardiovascular (CV) disease and mortality. The Framingham steatosis index (FSI) was recently proposed as a diagnostic marker of NAFLD and was calculated from age, body mass index, triglyceride, aspartate aminotransferase, alanine aminotransferase, diabetes history, and hypertension status. We aimed to evaluate the predictive ability of FSI for CV risk using a large-scale population dataset from the Korean National Health Insurance Service–National Health Screening Cohort (NHIS–HEALS).MethodsAmong 514,866 individuals in the NHIS–HEALS, we excluded those who died, had a history of admission due to a CV event, and were heavy drinkers. The final study cohort comprised 283,427 participants. We employed both unadjusted and covariate-adjusted models in Cox proportional hazards regression analyses to determine the association between FSI and major adverse cardiovascular events (MACEs), CV events, and CV mortality.ResultsDuring a median follow-up of 5.9 years, we documented 9,674, 8,798, and 1,602 cases of MACEs, CV events, and CV mortality, respectively. The incidence of MACEs was 1.28%, 2.99%, 3.94%, and 4.82% in the first to fourth quartiles of FSI, respectively. The adjusted hazard ratios (95% confidence interval) for MACEs gradually and significantly increased with the FSI quartiles [1.302 (1.215–1.395) in Q2, 1.487 (1.390–1.590) in Q3, and 1.792 (1.680–1.911) in Q4], following an adjustment for conventional CV risk factors, including age, sex, smoking, drinking, physical activities, low-density lipoprotein cholesterol, estimated glomerular filtration rate, and waist circumference. Participants in the higher quartiles of FSI exhibited a noteworthy increase in the occurrence of CV event. However, upon adjusting for relevant risk factors, the association between FSI and CV mortality did not reach statistical significance.ConclusionOur study suggests that the FSI, which is a surrogate marker of NAFLD, has a prognostic value for detecting individuals at higher risk of CV events.

背景非酒精性脂肪性肝病（NAFLD）普遍存在，与心血管疾病及死亡率密切相关。近期，弗拉明汉脂肪肝指数（FSI）被提出作为NAFLD的诊断标志物，该指数通过年龄、体重指数、甘油三酯、天冬氨酸转氨酶、丙氨酸转氨酶、糖尿病病史及高血压状态计算得出。本研究旨在评估FSI在利用韩国国民健康保险服务-国民健康筛查队列（NHIS-HEALS）的大规模人群数据集中预测心血管风险的能力。方法在NHIS-HEALS的514,866名个体中，我们排除了死亡者、因心血管事件入院史以及重度饮酒者。最终研究队列由283,427名参与者组成。我们采用未调整和协变量调整模型在Cox比例风险回归分析中确定FSI与主要不良心血管事件（MACEs）、心血管事件及心血管死亡率之间的关联。结果在平均随访5.9年的过程中，我们记录了9,674、8,798和1,602例MACEs、心血管事件及心血管死亡病例，分别。FSI的前四分位数中，MACEs的发生率分别为1.28%、2.99%、3.94%和4.82%。在调整了包括年龄、性别、吸烟、饮酒、体力活动、低密度脂蛋白胆固醇、估计肾小球滤过率及腰围在内的传统心血管风险因素后，随着FSI四分位数的增加，调整后的风险比（95%置信区间）逐渐且显著上升[在Q2中为1.302（1.215–1.395），在Q3中为1.487（1.390–1.590），在Q4中为1.792（1.680–1.911）]。然而，在调整了相关风险因素后，FSI与心血管死亡率之间的关联并未达到统计学意义。结论本研究表明，作为NAFLD替代标志物的FSI，对识别心血管事件高风险个体具有一定的预测价值。