Objective To estimate the risk of acute myocardial infarction (AMI) or stroke in adults with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH).
Design Matched cohort study.
Setting Population based, electronic primary healthcare databases before 31 December 2015 from four European countries: Italy (n=1 542 672), Netherlands (n=2 225 925), Spain (n=5 488 397), and UK (n=12 695 046).
Participants 120 795 adults with a recorded diagnosis of NAFLD or NASH and no other liver diseases, matched at time of NAFLD diagnosis (index date) by age, sex, practice site, and visit, recorded at six months before or after the date of diagnosis, with up to 100 patients without NAFLD or NASH in the same database.
Main outcome measures Primary outcome was incident fatal or non-fatal AMI and ischaemic or unspecified stroke. Hazard ratios were estimated using Cox models and pooled across databases by random effect meta-analyses.
Results 120 795 patients with recorded NAFLD or NASH diagnoses were identified with mean follow-up 2.1-5.5 years. After adjustment for age and smoking the pooled hazard ratio for AMI was 1.17 (95% confidence interval 1.05 to 1.30; 1035 events in participants with NAFLD or NASH, 67 823 in matched controls). In a group with more complete data on risk factors (86 098 NAFLD and 4 664 988 matched controls), the hazard ratio for AMI after adjustment for systolic blood pressure, type 2 diabetes, total cholesterol level, statin use, and hypertension was 1.01 (0.91 to 1.12; 747 events in participants with NAFLD or NASH, 37 462 in matched controls). After adjustment for age and smoking status the pooled hazard ratio for stroke was 1.18 (1.11 to 1.24; 2187 events in participants with NAFLD or NASH, 134 001 in matched controls). In the group with more complete data on risk factors, the hazard ratio for stroke was 1.04 (0.99 to 1.09; 1666 events in participants with NAFLD, 83 882 in matched controls) after further adjustment for type 2 diabetes, systolic blood pressure, total cholesterol level, statin use, and hypertension.
Conclusions The diagnosis of NAFLD in current routine care of 17.7 million patient appears not to be associated with AMI or stroke risk after adjustment for established cardiovascular risk factors. Cardiovascular risk assessment in adults with a diagnosis of NAFLD is important but should be done in the same way as for the general population.

目的评估成人非酒精性脂肪肝病 (NAFLD) 或非酒精性脂肪性肝炎 (NASH) 发生急性心肌梗死 (AMI) 或中风的风险。
设计匹配队列研究。
在 2015 年 12 月 31 日之前设置来自四个欧洲国家的基于人口的电子初级保健数据库：意大利 (n=1 542 672)、荷兰 (n=2 225 925)、西班牙 (n=5 488 397) 和英国 (n=12) 695 046）。
参与者120 795 名记录有 NAFLD 或 NASH 诊断且无其他肝脏疾病的成年人，在 NAFLD 诊断时（索引日期）按年龄、性别、执业地点和就诊进行匹配，记录在诊断日期之前或之后六个月，同一数据库中最多有 100 名没有 NAFLD 或 NASH 的患者。
主要结局指标主要结局是致命性或非致命性 AMI 事件以及缺血性或未明确的卒中。使用 Cox 模型估计危险比，并通过随机效应荟萃分析跨数据库进行汇总。
结果120 795 名有 NAFLD 或 NASH 诊断记录的患者被确定，平均随访时间为 2.1-5.5 年。调整年龄和吸烟情况后，AMI 的汇总风险比为 1.17（95% 置信区间为 1.05 至 1.30；NAFLD 或 NASH 参与者中发生 1035 起事件，匹配对照中发生 67 823 起事件）。在具有更完整的危险因素数据的一组中（86 098 名 NAFLD 和 4 664 988 名匹配对照），调整收缩压、2 型糖尿病、总胆固醇水平、他汀类药物使用和高血压后，AMI 的风险比为 1.01（ 0.91 至 1.12；患有 NAFLD 或 NASH 的参与者中有 747 个事件，匹配对照中有 37 462 个事件）。调整年龄和吸烟状况后，中风的汇总风险比为 1.18（1.11 至 1.24；NAFLD 或 NASH 参与者中有 2187 起事件，匹配对照中有 134 001 起事件）。在危险因素数据更完整的组中，进一步调整 2 型糖尿病、收缩压、总胆固醇后，中风的风险比为 1.04（0.99 至 1.09；NAFLD 参与者中有 1666 起事件，匹配对照中有 83 882 起事件）水平、他汀类药物的使用和高血压。
结论在对已确定的心血管危险因素进行调整后，目前 1770 万名患者的常规护理中 NAFLD 的诊断似乎与 AMI 或中风风险无关。对诊断为 NAFLD 的成人进行心血管风险评估很重要，但应采用与一般人群相同的方式进行。