Liver fibrosis by FibroScan^® independently of established cardiovascular risk parameters associates with macrovascular and microvascular complications in patients with type 2 diabetes

Background & Aims: Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are closely associated, and liver fibrosis has been related to macrovascular complications. We examined whether liver fibrosis, diagnosed by FibroScan^®, correlates with chronic vascular complications in a cohort of T2DM. Methods: We recruited 394 outpatients with T2DM attending five Italian diabetes centres who underwent liver ultrasonography (US), FibroScan^® and extensive evaluation of macrovascular and microvascular diabetic complications. Results: Steatosis by US was present in 89%. Almost all patients (96%) were on hypoglycaemic drugs, 58% had at least one chronic vascular complication, 19% a macrovascular complication (prior myocardial infarction and/or ischaemic stroke) and 33% a microvascular one (26% chronic kidney disease [CKD]; 16% retinopathy; 6% neuropathy). In all, 171 (72%) patients had CAP ≥ 248dB/m (ie hepatic steatosis), whereas 83 (21%) patients had LSM ≥ 7.0/6.2 kPa (M/XL probes) (significant liver fibrosis). CAP was not associated with any macro/microvascular complications, whereas LSM ≥ 7.0/6.2 kPa was independently associated with prior cardiovascular disease (adjusted OR 3.3, 95%CI 1.2-8.8; P =.02) and presence of microvascular complications (adjusted OR 4.2, 95%CI 1.5-11.4; P =.005), mainly CKD (adjusted OR 3.6, 95%CI 1.3-10.1; P =.01) and retinopathy (adjusted OR 3.7, CI 95% 1.2-11.9; P =.02). Neither diabetes duration nor haemoglobin A1c differed according to CAP or LSM values. Conclusion: Significant fibrosis, detected by FibroScan^®, is independently associated with increased prevalence of macrovascular and microvascular complications, thus opening a new scenario in the use of this tool for a comprehensive evaluation of hepatic and vascular complications in patients with T2DM.