S2669 Rising Cardiovascular Mortality Due to Non-Alcoholic Fatty Liver Disease: Trends, Disparities and Projections Using the CDC-WONDER Database

Introduction: Nonalcoholic fatty liver disease (NAFLD) is a spectrum of liver injury that can lead to cirrhosis and carcinoma, is closely linked to metabolic syndrome and dysregulated cytokine secretion, increasing the risk of atherosclerotic cardiovascular disease (ASCVD). NAFLD can independently contribute to CV mortality. This study analyzed NAFLD-related cardiovascular mortality (NAFLD-CVM) using a national death certificate database. Methods: The CDC-WONDER (1999–2023) was queried for NAFLD-CVM in individuals aged >25 using International Classification of Diseases, Tenth Revision (ICD-10) codes. Age-adjusted mortality rates (AAMR) per 1,000,000 were analyzed. Annual percentage change (APC) and average annual percentage change (AAPC) were calculated using Joinpoint regression. An autoregressive integrated moving average model projected death through 2030. Results: In 1999, there were 606 NAFLD-CVM deaths (CDR: 3.4), rising to 1294 in 2023 (CDR: 5.6). Projections estimate 1791 deaths by 2030 (95% CI: 1201–2382; CDR: 7.4, 95% CI: 4.7–10.2). Among men, AAMR declined until 2014(APC: – 2.12), then rose (APC: 6.5), with an AAPC of 1.03 (P = 0.01). Women had a modest rise until 2015 (APC: 1.27), followed by a sharp increase (APC: 10.08), resulting in an AAPC of 4.13(P < 0.001). In White Americans (WA), AAMR declined slightly until 2014, then rose (APC: 7.48), producing an AAPC of 2.49(P < 0.001). African Americans (AA) showed a decline until 2014 (APC: – 4.82), followed by a reversal (APC: 9.13), with an overall AAPC of 0.19 (P = 0.69). WA men declined through 2014 (APC: – 1.59), then increased (APC: 6.57), with an AAPC of 1.39 (P = 0.01). AA men dropped from 1999–2012 (APC: – 6.7), then rose (APC: 6.85), but the AAPC remained non-significant (– 0.71, P = 0.29). WA women had a non-significant rise until 2014 (APC: 1.56), followed by a marked increase (APC: 10.37), leading to an AAPC of 4.78 (P < 0.001). AA women declined until 2016 (APC: – 2.38), then rose (APC: 9.72), with an AAPC of 1.01 (P = 0.22). Regionally, the Northeast showed a non-significant AAPC (0.18, P = 0.54). The Midwest showed steady growth, with a sharp rise from 2009 (APC: 8.17), and an AAPC of 4.73 (P < 0.001). The South and West initially declined, then rose significantly, with AAPCs of 3.1 (P < 0.001) and – 0.89 (P = 0.01), respectively. Conclusion: NAFLD-CVM is increasing and projected to rise further in the U.S. AAMR is rising most notably among women, especially WA women with significant regional increases in the Midwest, South and West. NAFLD screening should be integrated into cardiometabolic risk assessment strategies.