Prevalence of Subclinical Cardiovascular Disease in Patients with Nonalcoholic Fatty Liver Disease: Analysis of the Paracelsus 10,000 Cohort Study

Florian Koutny, Elmar Aigner, Christian Datz, Sophie Gensluckner, Andreas Maieron, Andrea Mega, Bernhard Iglseder, Patrick Langthaler, Vanessa Frey, Bernhard Paulweber, Eugen Trinka, Bernhard Wernly*

*Corresponding author for this work

Research output: Journal article (peer-reviewed)Journal article

1 Citation (Scopus)


Background: In patients with nonalcoholic fatty liver disease (NAFLD), cardiovascular diseases are more often the cause of death than the liver disease itself. However, the prevalence of atherosclerotic manifestations in individuals with NAFLD is still uncertain. This study aimed to explore the association between NAFLD and coronary artery calcification (CAC) in a Central European population. Methods: A total of 1,743 participants from the Paracelsus 10,000 study were included. The participants underwent CAC scoring and were assessed for fatty liver index (FLI), fibrosing nonalcoholic steatohepatitis (NASH) index (FNI), and fibrosis-4 index (FIB-4 score), which are indicators for steatosis and fibrosis. Multivariable logistic regression models were calculated. Results: Results revealed an association between liver steatosis/fibrosis and CAC. An FLI >60 was associated with higher odds of NAFLD (odds ratio [OR] 3.38, 95% CI: 2.61–4.39, p < 0.01) and increased prevalence of CAC score >300 compared to FLI <30 (9% vs. 3%, p < 0.01), even after adjusting for traditional cardiometabolic risk factors. While the crude ORs of the FIB-4 scores ≥ 1.3 and FNI score were significantly associated with increased odds of CAC, they became nonsignificant after adjusting for age, sex, and MetS. Conclusion: This study reveals a significant association between NAFLD and CAC. The findings suggest that assessing liver fat and fibrosis could enhance the assessment of cardiovascular risk, but further research is needed to determine whether hepatic fat plays an independent role in the development of atherosclerosis and whether targeting liver steatosis can mitigate vascular risk.

Original languageEnglish
Pages (from-to)272-280
Number of pages9
JournalMedical Principles and Practice
Issue number4-5
Publication statusPublished - 07 Nov 2023


  • Coronary artery calcification
  • Fatty liver index
  • Fibrosis-4 index
  • FNI fibrotic nonalcoholic steatohepatitis index
  • Nonalcoholic fatty liver disease
  • Paracelsus 10,000 cohort study

ASJC Scopus subject areas

  • General Medicine


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