Liver Disease Linked to Higher Rate of Cardiovascular Disease

Key Takeaway

  • Patients with liver disease had a twofold higher incidence of cardiovascular disease (CVD) than those without liver disease, with notable geographical variations, in an observational study. The paper is published as a preprint and has not yet been peer reviewed.

Why This Matters

  • The study highlights significant geographical variations of liver disease burden, suggesting possible variations in risk factors and access to diagnostic services. The results have policy implications for CVD prevention and identification of high-risk and underserved patients with liver disease, the authors suggest. 

Study Design

  • Using electronic health records (EHRs) for almost four million adults in England, researchers assessed incidence of CVD in patients with one of five liver conditions: alcoholic liver disease, autoimmune liver disease, hepatitis B virus, hepatitis C virus, and nonalcoholic fatty liver disease.

  • Investigators looked at the first record of a cardiovascular presentation in five CVD categories: coronary heart disease, strokes and transient ischemic attack, peripheral vascular disease, cardiomyopathy, and arrhythmia. Incidence rates per 100,000 person-years for liver disease and CVD were estimated based on the period from January 1, 2015, to December 31, 2019.

Key Results

  • The age-standardized incidence rate for any liver disease was 114.5 per 100,000 person years (95% CI, 112.5 – 116.6).

  • The age-standardized incidence rate for CVD in patients with any liver disease was 2634.6 per 100,000 person years (95% CI, 2524.4 – 2744.8) vs 1339.7 per 100,000 person years (95% CI, 1332.3 – 1347) for those without liver disease.

  • The different types of liver disease did not influence CVD presentation. Atrial fibrillation was the most common CVD condition among patients with liver disease, whereas hypertrophic cardiomyopathy was the least common.

  • After calculating excess years of life lost, researchers showed patients with liver disease experience premature mortality due to CVD.


  • Available data pertain only to England, which may limit generalizability to other countries.

  • As this is an observational study, there may be residual confounding.

  • Electronic health records commonly have missing data.

Study Disclosures

  • Senior author Alvina G. Lai, PhD, is supported by funding from the Wellcome Trust, National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, the Academy of Medical Sciences, NIHR Great Ormond Street Hospital Biomedical Research Centre, and the Health Data Research UK Better Care Catalyst Award. 

  • Co-author Graham R. Foster, PhD, receives funding from companies that manufacture drugs for hepatitis C virus (AbbVie, Gilead, MSD) and consults for GSK, Arbutus, and Shionogi in areas unrelated to this research. 

This is a summary of a preprint research study by Wai Hoong Chang from the Institute of Health Informatics, University College London, UK, and colleagues on MedRxiv provided to you by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found on

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