S4-9.1 – Growing NAFLD-Diabetes Dual Prevalence Increases CVD Risk for Diabetics

S4-9.1 - Growing NAFLD-Diabetes Dual Prevalence Increases CVD Risk for Diabetics
In a preview of the premier episode of The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide, key opinion leaders Doctors Stephen Harrison, Kathleen Corey and Kay Pepin join co-hosts Dr. Ken Cusi and Roger Green to discuss key issues related to the NAFLD-Diabetes Link.

A critical focus of this segment examines NAFLD-Diabetes Dual Prevalence: very high NAFLD and NASH prevalence in diabetics leads to increased CVD risk and other metabolic issues.

This week, SurfingNASH is offering conversation segments to showcase our new series, The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide. Rising Tide, as we call it, is a subscription-only series targeted at the primary care physicians, endocrinologists and allied health professionals who provide front-line treatments for patients living with Type 2 Diabetes and/or obesity.

This sample session comes from the debut episode which focuses on research that has led AACE to issue guidelines, AGA to propose clinical care pathways and AHA to produce a white paper on the links between Fatty Liver Disease and CVD Risk. Endocrinology researcher and key opinion leader Ken Cusi discusses his work looking at NAFLD and NASH in diabetic patient populations. He covers studies confirming that patients with diabetes are at least twice as likely to have NAFLD or NASH as non-diabetics. He notes that this effect is confirmed in overweight as well as obese patients and is proven independent of obesity (an important note: the two together are worse than either alone). In practical terms, he asserts that primary care and endocrinology clinics are the places we can identify NAFLD and early NASH before these become later-stage fibrosis or cirrhosis requiring attention from hepatologists. In that context, he notes that twice as many patients in an endocrinology clinic will test positive for NAFLD or NASH compared to a primary care clinic, thus making endocrinologists a vital target group for earlier identification and treatment of Fatty Liver Disease. In his practice, Ken advocates for every patient to receive a FIB-4 test, which can be found in most EMR systems and is an inexpensive, reasonably reliable negative predictor for F3 or F4 status.

Next, hepatology researcher and key opinion leader Kathleen Corey discusses some of her research on the link between CVD and NAFLD. Two key conclusions: over a relatively short period after initial induction into the study (median of 25.5 months), the presence of NAFLD causes a 70% increase in relative risk (4.1% vs. 2.6%) of a Major Adverse Cardiovascular Event (MACE). She agrees with Ken’s suggestion about FIB-4. She also notes the trend of primary care physicians to discontinue statins if the patient’s ALT level starts to rise and cautions that this step is likely to increase patient risk.

Finally, Kay Pepin, Director of Research Translation for Resoundant Inc. under joint appointment with the Mayo Clinic, discusses research demonstrating that a relatively simple MRE session can provide the information necessary to determine the likelihood that fibrosis will advance to cirrhosis or compensated cirrhosis will advance to decompensated states. She also notes that with insurance coverage, this is not an expensive test for many people. By adding a simple MRI module to the MRE session, physicians can derive a significant amount of additional information.

If you enjoy this preview, please visit our website and sign up to listen to the full episode and more exclusive content. We also kindly ask that you submit reviews wherever you download our discussions or, alternatively, write to us directly at questions@SurfingNASH.com.

This podcast series and all the episodes are produced under a non-restricted grant from Novo Nordisk. Novo Nordisk has neither influenced nor reviewed the contents of this podcast in any way. This content represents the views of the speakers and does not necessarily represent the views of Novo Nordisk. The content herein is for educational purposes only and should not be taken as medical advice.

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