Alcohol-Related Liver Disease Associated With Short-Term CVD Risk, Mortality

Patients with alcohol-related liver disease are at increased risk for cardiovascular disease.

Alcohol-related liver disease is associated with increased rates of cardiovascular diseases (CVDs) in the short term. These findings were published in Clinical Gastroenterology and Hepatology.

Investigators from Karolinska Institutet in Sweden sourced data for this population-based cohort study from the ESPRESSO (Epidemiology Strengthened by Histopathology Reports in Sweden) cohort, which invited all pathology departments in the country to share gastrointestinal biopsy data collected between 1969 and 2017. For this study, patients (n=3488) who had both liver biopsy and alcohol-related liver disease data were evaluated for CVD risk on the basis of linked data in the National Patient Register. Risk was compared with a group of 15,461 matched individuals.

The alcohol-related liver disease and control cohorts included individuals with a mean age of 57.0 (SD, 11.4) and 56.0 (SD, 11.3) years and that were 63.6% and 62.4% men, respectively. Of these individuals, 21.6% and 1.6% had a history of alcohol use disorder (AUD), 16.2% and 0.0% a history of liver decompression, 9.3% and 1.8% a history of hypertension, and 1.3% and 0.2% a history of obesity, respectively.

Among the alcohol-related liver disease cohort, 2039 had cirrhosis, 437 had steatosis, 418 had fibrosis, 82 had a normal liver, and 512 had other alcohol-related liver diseases.

Active surveillance of modifiable CVD risk factors should be considered by clinicians treating patients with ALD.

During an average follow-up of 7.0 years among the alcohol-related liver disease cohort and 15.4 years among the controls, the cumulative incidence of CVD was higher among the alcohol-related liver disease group at 1 (4.2% vs 1.2%), 5 (11.5% vs 6.2%), 10 (18.0% vs 13.7%), and 40 (33.1% vs 52.7%) years after the index date, respectively.

The incidence rates of CVD per 1000 person-years were 19.0 among controls compared with 35.6 for the alcohol-related liver disease group overall and 39.4 for those with cirrhosis, 34.2 for those with fibrosis, 31.6 for those with steatosis, 31.2 for those with other alcohol-related liver diseases, and 27.4 for those with a normal liver.

The alcohol-related liver disease cohort was also associated with higher rates of liver transplant (2.7% vs 0.0%), inpatient or outpatient visits related with AUD (32.0% vs 3.5%), and non-CVD-related death (55.8% vs 13.9%) compared with controls, respectively.

In the fully adjusted model, alcohol-related liver disease was associated with decreased risk for CVD at up to 50 years (subdistribution hazard ratio [sHR], 0.86), likely because less than half of the ALD cohort survived beyond 10 years. Stratified by alcohol-related liver disease etiology, CVD risk was highest for those with steatosis (sHR, 1.46) and lowest for those with liver decompensation (sHR, 0.62).

During the first ten years of follow-up alcohol-related liver disease was associated with increased risk for CVD death (sHR, 1.48) and stroke (sHR, 1.26).

In general, women with alcohol-related liver disease were at higher risk for CVD (sHR, 1.12) than men (sHR, 0.75).

A potential limitation of this study is that the indication for liver biopsy is unknown.

“Persons with biopsy-proven ALD [alcohol-related liver disease] have increased rates of CVD across histological subgroups compared to matched reference individuals, particularly just after ALD diagnosis,” the researchers wrote. “Active surveillance of modifiable CVD risk factors should be considered by clinicians treating patients with ALD.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Hagström H, Thiele M, Sharma R, et al. Cardiovascular outcomes in patients with biopsy-proven alcohol-related liver disease. Clin Gastroenterol Hepatol. Published online November 1, 2022. doi:10.1016/j.cgh.2022.10.022