The prevalence of coronary artery disease in patients with liver cirrhosis: a meta-analysis

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Liver cirrhosis is one of the major causes of mobility and mortality in the world and brings a great burden to the society. The prevalence of atherosclerosis and coronary artery disease (CAD) has been considered to be low among patients with cirrhosis than in the general population on the basis of previous autopsy studies. Because of liver dysfunction, cirrhotics may be associated with lower lipid profile, coagulation disorder, thrombocytopenia, and hyperdynamic circulation. Because of these factors, liver cirrhosis was even regarded as a protective factor of CAD. However, accumulating evidences have shown that CAD is not rare in cirrhotics and the reported rates of CAD are widely varying. Therefore, we conducted a meta-analysis to evaluate the prevalence of CAD among patients with cirrhosis and provide evidence for the clinical practice.
We reviewed published studies in MEDLINE and EMBASE databases from their inception to July 2017 with search strategy that included the terms for ‘liver cirrhosis’ and ‘coronary artery disease’. A manual search for additional studies or using references of selected retrieved articles was also carried out to identify other possible studies. The major inclusion criteria were observational studies that reported prevalence of CAD or related data that can be used to calculate prevalence among patients with liver cirrhosis. Data extraction was performed independently using a predefined data extract form by two reviewers. If both the obstructive (>50%) and nonobstructive CAD data were reported, we only extracted obstructive CAD data. Disagreement was resolved by discussion among all investigators. The analysis was performed using Stata 12.0 software (StataCorp., College Station, Texas, USA). In view of the predictable heterogeneity between studies, the random effects model was deployed.
Of potentially 82 relevant published studies, 73 were excluded because of duplication or title and abstract not meeting inclusion criteria. Subsequently, four articles were excluded because they did not describe the outcomes of interest. Finally, five observational studies 1–5 met all inclusion criteria.
Five studies with 12 924 patients with cirrhosis of various etiologies were included in the analysis to assess the prevalence of CAD in cirrhotics. The estimated prevalence of CAD among patients with cirrhosis was 12.6% (95% confidence interval: 6.8–18.3%). Forest plot is presented in Fig. 1.
So far, this is the first meta-analysis carried out summarize all presently available data on the prevalence of CAD among cirrhotic. Our study demonstrated an estimated prevalence of CAD in cirrhotics of 12.6%, which is similar to reported prevalence of CAD in population without cirrhosis 1,5. The result validates that CAD is not uncommon in patients with liver cirrhosis. Liver cirrhosis does not seem to have a protective effect against CAD. The prevention and treatment of CAD including statins use in patients with cirrhosis deserve more attention.

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