Pulmonary hypertension is associated with an increased incidence of NAFLD: A retrospective cohort study of 18,910 patients.

Background Pulmonary hypertension (PH) represents a multicausal disease with increasing global incidence that eventually leads to right ventricular failure. In addition to cardiac sequelae, non-cardiac comorbidities appear to be of increasing relevance, especially in times of improved therapeutic options that often result in long-term survival. Here, we examined a potential association between PH and non-alcoholic fatty liver disease (NAFLD) as well as liver cirrhosis in an outpatient cohort in Germany. Methods A total of 9,455 PH patients followed in general and internist practices between 2005 and 2019 were matched by propensity scoring based on age, sex, yearly consultation frequency and relevant co-morbidities (obesity, diabetes, heart failure, lipid metabolism disorders) to a cohort of equal size without PH. The association between PH and NAFLD/liver cirrhosis was evaluated using Cox regression models. Results Within 10 years from the index date, cumulative incidence rates of NAFLD were significantly higher among patients with PH (7.3%) compared to non-PH patients (3.5%, log-rank p 80 years (HR: 3.30, p = 0.001). Moreover, PH patients showed a strong trend towards higher incidence rates of liver cirrhosis compared to non-PH patients (1.4 vs. 1.1%, p = 0.066). Conclusion Our data suggests that incidence rates of NAFLD are strongly elevated in patients with PH. This finding should trigger awareness of non-cardiac comorbidities in these patients and argues for potential liver-directed screening programs in patients with PH. This article is protected by copyright. All rights reserved.