Introduction and Objective: Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are closely associated with an increased risk of congestive heart failure (CHF). This study aimed to evaluate the long-term incidence of CHF in patients with NAFLD according to glycemic status, using a nationwide cohort of Korean adults.Methods: This longitudinal cohort study included 1,097,698 individuals with NAFLD who underwent a national health screening in 2009, with follow-up extending until CHF diagnosis or the end of 2020. The association between T2DM and the risk of incident CHF was assessed using Cox proportional hazards regression analysis. Baseline glycemic status was classified into normal fasting glucose (NFG), impaired fasting glucose (IFG), and T2DM.Results: Over a median follow-up period of 11.3 years, 62,115 cases of CHF were identified. After adjusting for confounding variables, individuals with T2DM had a significantly elevated risk of CHF, with a hazard ratio of 1.406 (95% CI 1.38-1.432) compared to those without T2DM. When categorized by glycemic status, the T2DM group exhibited a higher risk of CHF (HR 1.413, 95% CI 1.385-1.441) compared to the NFG group, whereas the IFG group did not show a statistically significant increase in risk. The increased risk of CHF attributable to T2DM is more pronounced in individuals with fewer conventional risk factors, including younger age, non-drinking status, non-obesity, and the absence of atrial fibrillation.Conclusion: T2DM is an independent risk factor for CHF in patients with NAFLD. These findings underscore the importance of early detection and optimal management of T2DM in individuals with NAFLD to reduce the risk of CHF.
E. Roh: None. K. Son: None.
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