Impact of NAFLD on the Incidence of Cardiovascular Diseases in a Primary Care Population in Germany

  • Christian Labenz
  • Yvonne Huber
  • Maurice Michel
  • Michael Nagel
  • Peter R. Galle
  • Karel Kostev
  • Jörn M. SchattenbergEmail author
Original Article



Patients with NAFLD are considered at a high risk of cardiovascular events due to underlying metabolic risk factors. Currently, data related to the impact of NAFLD on cardiovascular risk in the general population are lacking.


The aim of this study was to investigate the role of NAFLD on risk of myocardial infarction (MI), coronary heart disease (CHD), atrial fibrillation (AF), and stroke in primary care in Germany.


The study included patients diagnosed with NAFLD in primary care between 2010 and 2015. NAFLD cases (n = 22,048) were matched to a cohort without NAFLD (n = 22,048) based on age, sex, treating physician, type 2 diabetes, arterial hypertension, and hyperlipidemia. The primary outcome of the study was the incidence of MI, CHD, AF, and stroke.


Within 10 years of the index date, 12.8% of patients with NAFLD and 10.0% of controls were diagnosed with CHD (p < 0.001). Additionally, frequency of MI was significantly higher in NAFLD (2.9% vs. 2.3%, p < 0.001). On regression analysis, HR for incidence of MI was 1.34 (p = 0.003) in all NAFLD patients and 1.35 (p = 0.013) for men. Incidence of AF was significantly higher in patients with NAFLD. On regression analysis, HR for incidence of AF was 1.15 (p = 0.005). NAFLD was not associated with a higher incidence of stroke (HR 1.09, p = 0.243).


NAFLD constitutes an independent risk factor for CHD, MI, and AF in primary care in Germany. Identification of patients with NAFLD in primary care will allow specifically managing and modifying underlying risk factors to improve the overall prognosis.


Stroke Myocardial infarction NASH NAFLD Atrial fibrillation Cardiovascular disease Metabolic syndrome 



Nonalcoholic fatty liver disease


Nonalcoholic steatohepatitis


Cardiovascular disease


Low-density lipoprotein


High-density lipoprotein


Author’s contribution

CL, KK, and JMS performed research; CL, YH, MM, MN, PRG, KK, and JMS designed the experiments and analyzed the data; KK provided reagents/materials/analysis tools; CL and JMS wrote the paper; and KK was involved in statistical analysis. All authors approved the final version of the manuscript and the authorship list.


This work was in part funded by intramural finds of the University Medical Center Mainz.

Compliance with Ethical Standards

Conflict of interest

KK is an employee of IQVIA. JMS has acted as consultant to: Boehringer Ingelheim, Galmed, Genfit, Gilead Sciences, Intercept Pharmaceuticals, IQVIA, and has received research funding from Gilead Sciences. The other authors have nothing to declare.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal Medicine IUniversity Medical Centre of the Johannes Gutenberg-UniversityMainzGermany
  2. 2.Metabolic Liver Research ProgramUniversity Medical Centre of the Johannes Gutenberg-UniversityMainzGermany
  3. 3.EpidemiologyIQVIAFrankfurtGermany

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