Evaluating the risk of incident cardiovascular disease and cardiovascular drug prescribing patterns in patients with liver disease

Date of Approval: 
2021-03-23 00:00:00
Lay Summary: 
Cardiovascular disease (CVD) remains the leading cause of death globally. Patients with CVD have an increased prevalence of other metabolic disease like diabetes, obesity and fatty liver disease. Likewise, chronic liver disease (CLD) contributes significantly to mortality and morbidity burden across populations and patients with CLD are at increasing risk of developing CVD. The project aims to explore the risk of developing new CVD in patients with CLD. We will investigate risk across demographic groups (age and sex) and across the types of CLD (non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), viral hepatitis, fibrosis and cirrhosis). For patients who developed CVD, we will investigate prescribing patterns of CVD drugs and analyse adherence and persistence to these drugs. So far, most studies investigating the relationship between CVD and CLD have focused on NAFLD and no large-scale studies have been conducted across a wide range of liver and cardiovascular conditions to understand disease trends and prescribing patterns. Our findings may be used to inform treatment strategies in patients with CLD.
Technical Summary: 
Cardiovascular diseases (CVDs) contributes to the largest fraction of deaths (~17million globally). There is growing evidence for the association of CVD with type 2 diabetes and obesity and a growing recognition of non-alcoholic fatty liver disease (NAFLD) as a potential risk factor. However, other chronic liver diseases (CLDs) have not received adequate attention and this project aims to understand the extent by which CLDs pose a risk to developing subsequent fatal and non-fatal CVDs. We will investigate risk across demographic groups (age and sex) and across the types of CLD (non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), viral hepatitis, fibrosis and cirrhosis). We will employ linked primary care, secondary care and mortality data in England to investigate the incidence rates of CVD in patients with CLD. We will analyse prescribing patterns of CVD medications in these patients. We will perform a large-scale propensity score analysis to match cases (patients undergoing CVD therapy) to controls followed by time-dependent Cox modelling on a mortality (all-cause, cardiovascular, cancer and liver). We will explore adherence to and persistence with CVD drugs in patients with CLD. Our findings may be used to design new screening strategies in CLD patients at risk of CVD conditions and inform treatment strategies in these patients.
Health Outcomes to be Measured: 
Stable angina; Unstable angina; Coronary disease; Non-fatal myocardial infarction; Stroke not further specified; Heart failure; Peripheral arterial disease; Abdominal aortic aneurysm; Stroke; Arrhythmia/sudden cardiac death; Unheralded coronary death; Atrial fibrillation; Mortality all cause; Cancer related mortality; Liver-related mortality; Cardiovascular mortality
Application Number: 
21_000363
Collaborators: 

Alvina Lai - Chief Investigator - University College London ( UCL )
Alvina Lai - Corresponding Applicant - University College London ( UCL )
Stefanie Mueller - Collaborator - University College London ( UCL )
Wai Chang - Collaborator - University College London ( UCL )

Linkages: 
HES Admitted Patient Care;ONS Death Registration Data