Nonalcoholic fatty liver disease frequently coexists with diabetes (DM), and both are associated with an increased risk of coronary heart disease (CHD). The effect of nonalcoholic fatty liver disease progression or regression on the severity of coronary artery disease (CAD) in patients with CHD or DM remains unclear. In this multicenter study, 3126 patients with CHD, hepatic steatosis and fibrosis were assessed using the hepatic steatosis index (HSI) and fibrosis-4 index. CAD severity was evaluated using coronary angiography. After adjusting for confounders, hepatic steatosis (HSI > 36) was found to be associated with an increased risk of multivessel CAD. In patients with both hepatic steatosis and significant fibrosis (HSI > 36, fibrosis-4 index ≥ 1.3), the risk was further elevated (odds ratio [OR]: 1.596; 95% confidence interval [CI]: 1.245-2.046), with a stronger association in patients with DM (OR: 1.988; 95% CI: 1.041-3.835). Hepatic steatosis and/or significant fibrosis were associated with CAD severity, especially in individuals with both CHD and DM.
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