Data underlying the publication "Fatty Liver Index and mortality after myocardial infarction: A prospective analysis in the Alpha Omega Cohort"

Data in this repository consists of the metadata, a read-me file, and the codebook, but not the minimal dataset to reproduce the results of the corresponding manuscript. The dataset is secured at the Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.<br>Accumulating evidence shows that NAFLD might play a role in the etiology and progression of CVD, but little is known on the association of NAFLD and CVD mortality in patients with a history of a myocardial infarction (MI). Therefore, we studied the relationship of Fatty Liver Index (FLI), as indicator for non-alcoholic fatty liver disease (NAFLD), with 12-year risk of cardiovascular disease (CVD) and all-cause mortality in post-MI patients. We included 4165 Dutch patients from the Alpha Omega Cohort aged 60-80 years who had an MI ≤10 years prior to study enrolment. NAFLD was defined as FLI ≥60. Patients were followed for cause-specific mortality from enrolment (2002-2006) through December 2018. Hazard ratios for CVD and all-cause mortality were obtained by multivariable Cox regression using FLI &lt;30 (indicating absence of NAFLD) as the reference. Baseline FLI as a continuous measure were studied with mortality using restricted cubic splines analyses. The median (IQR) FLI was 68 (48-84). Sixty percent of the patients had FLI ≥60, who were more likely to be male and more often had diabetes, high blood pressure and high serum cholesterol levels. During 12 years of follow-up, 2042 deaths occurred of which 846 from CVD. Patients with NAFLD were at increased risk of CVD mortality (HR: 1.55 [1.19, 2.03]) and all-cause mortality (HR: 1.21 [1.03; 1.41]) compared to patients without NAFLD. Results remained consistent after excluding patients with obesity and diabetes. To conclude, the adverse association of FLI with CVD mortality were stronger in female than in male patients with conventional cut-off points. FLI ≥60, indicating NAFLD, was a predictor for CVD and all-cause mortality in post-MI patients, independent of other cardiometabolic risk factors. However, cut-off points might differ between male and female patients for predicting CVD mortality.

本仓库所包含的数据涵盖元数据、说明文档与编码手册，但未提供用于复现对应研究论文成果的最小数据集。该数据集由荷兰瓦赫宁根大学及研究中心人类营养与健康分部托管。

越来越多的证据表明，非酒精性脂肪性肝病（non-alcoholic fatty liver disease, NAFLD）可能参与心血管疾病（cardiovascular disease, CVD）的病因形成与病情进展，但目前针对有心肌梗死（myocardial infarction, MI）病史的患者，其NAFLD与心血管疾病死亡率之间的关联仍鲜有研究。为此，本研究以脂肪变指数（Fatty Liver Index, FLI）作为非酒精性脂肪性肝病的评估指标，探究其在心肌梗死后患者中与12年心血管疾病死亡率及全因死亡率的关联。

本研究纳入了来自Alpha Omega队列的4165名荷兰受试者，年龄介于60至80岁之间，且在研究入组前10年内曾发生心肌梗死。本研究将FLI≥60定义为非酒精性脂肪性肝病。研究对象自2002-2006年入组起，至2018年12月止，被追踪随访其死因特异性死亡率。以FLI<30（提示无NAFLD）作为参照组，通过多变量Cox回归分析计算心血管疾病与全因死亡率的风险比（hazard ratios, HR）。同时采用限制性立方样条分析，将基线FLI作为连续变量探究其与死亡率的关联。

本研究中受试者的FLI中位数（四分位距）为68（48-84）。其中60%的患者FLI≥60，这类人群更大概率为男性，且更常合并糖尿病、高血压及高血清胆固醇血症。

在12年的随访期间，共计发生2042例死亡，其中846例死于心血管疾病。与无NAFLD的患者相比，合并NAFLD的患者心血管疾病死亡率（HR: 1.55 [95%CI: 1.19, 2.03]）与全因死亡率（HR: 1.21 [95%CI: 1.03, 1.41]）均显著升高。在排除肥胖与糖尿病患者后，上述结果仍保持一致。

综上，以常规截断值为判定标准时，FLI与心血管疾病死亡率的不良关联在女性患者中强于男性患者。FLI≥60（提示合并NAFLD）可作为心肌梗死后患者心血管疾病及全因死亡率的独立预测因子，不受其他心脏代谢危险因素的影响。不过，用于预测心血管疾病死亡率的截断值可能存在性别差异。