S2335 Liver to Heart: A 20-Year Analysis of Cardiovascular-Related Mortality Trends in Fibrosis and Cirrhosis of the Liver in the United States

Introduction: Heart disease is the first leading cause of death in the United States. Liver fibrosis and cirrhosis are linked to an increased risk of developing cardiovascular disease (CVD). This study aimed to evaluate the temporal trends and disparities in mortality from CVD among adults with fibrosis and cirrhosis of the liver in the United States from 1999 to 2020. Methods: A detailed analysis of death certificates from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database was done. Records from 1999 to 2020 were evaluated, using the International Classification of Diseases, Tenth Revision (ICD-10) codes I00-I99 and K74 to identify CVD-related deaths in fibrosis and cirrhosis of the liver among adults aged ≥25 in the United States. Age-adjusted mortality rates (AAMRs) per 100,000 population were extracted and stratified by year, sex, race/ethnicity, census region, and state. Results: The study identified 787,375 deaths among patients with fibrosis and cirrhosis of the liver, out of which 308,257 were CVD-related. Between 1999 and 2007, the overall AAMR declined from 6.48 (6.36-6.60, CI 95%) to 5.26 (5.16-5.36, CI 95%). Thereafter, it increased to 7.33 (7.22-7.43, CI 95%) by 2019, followed by a steep rise in 2020, reaching 8.52 (8.40-8.63, CI 95%). Men had a higher AAMR (8.70; 8.66-8.74, CI 95%) than women (4.41; 4.38-4.43, CI 95%). American Indians or Alaska Natives reported the highest AAMR (10.17; 9.85-10.49, CI 95%), followed by Whites (6.44), Blacks or African Americans (6.42), and Asians or Pacific Islanders (4.26). Analysis by region showed the highest AAMR in the West (7.02; 6.97-7.07, CI 95%), followed by the South (6.92), the Northeast (6.01), and the Midwest (5.18). Texas exhibited the highest AAMR of 9.78 (9.67-9.89, CI 95%), whereas Utah had the lowest (3.71; 3.49-3.93, CI 95%). Conclusion: There was an initial decline in CVD-related mortality among fibrosis and cirrhosis patients, followed by a significant rise, particularly from 2019 to 2020. The mortality rates were especially higher in men, American Indians or Alaska Natives, and individuals living in the West region of the United States. Notably, Texas has been affected more than the other states. Developing effective preventive and therapeutic strategies is essential to address the elevated mortality rates among these groups.