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Background: Non alcoholic fatty liver disease is an independent risk factor for coronary artery disease. But its effect
on acute coronary syndrome is not clear. We performed this study to identify the prevalence of NAFLD in patients
with ACS admitted to a tertiary care center in Sri Lanka. We also described the association of NAFLD with the
severity of ACS predicted by the GRACE score.
Methods: We performed a descriptive study including all consecutive patients with non-fatal ACS admitted to
Colombo South Teaching Hospital from 01/02/2014 to 30/04/2014. Patients with excessive alcohol consumption,
established cirrhosis and patients with identified risk factors for liver disease were excluded from the study. All
patients underwent ultrasound scan of liver.
Results: There were 120 participants, 75 (62.5 %) males and 45 (37.5 %) females with acute coronary syndrome.
Average age was 61.28 ± 11.83 years. NAFLD was seen in 56 (46.7 %) patients with ACS. Patients with NAFLD had
a higher GRACE score than patients without NAFLD (120.2 ± 26.9 Vs 92.3 ± 24.2, p < 0.001). Increased age and
presence of NAFLD conferred a higher mortality risk from ACS as predicted by GRACE score. Patients with NAFLD
had a higher predicted mortality during in-ward stay (adjusted OR 31.3, CI 2.2–439.8, p = 0.011) and at 6 months
after discharge (adjusted OR 15.59, CI 1.6–130.6, p = 0.011).
Conclusions: Patients with NAFLD have a higher predicted mortality from acute coronary syndrome and thus
require aggressive treatment of CAD. It is important to consider this novel risk factor when risk stratifying patients
with ACS.
Keywords: Non alcoholic fatty liver disease, Acute coronary syndrome, Mortality, Sri Lanka
