Effect of median liver stiffness on chronic heart failure by alcohol intake in the NHANES population: A cross-sectional study

While the relationship between liver stiffness and heart failure (HF) has been studied widely, alcohol-related differences in the association between liver stiffness and chronic heart failure (CHF) in the general population remains unclear. This study aimed to examine whether alcohol intake modifies the effect of median liver stiffness (elasticity) on CHF. This cross-sectional study analyzed the data of 6894 participants in the prepandemic National Health and Nutrition Examination Survey database dated from 2017 to March 2020. The exposure variable was the median liver stiffness, and the outcome was CHF. The association between median liver stiffness and CHF, overall and stratified by alcohol consumption, was explored, and interaction effects were tested. The participants' mean age was 50.13 ± 17.43 years, and the median liver stiffness was 5.00 (4.10-6.10) kPa. The prevalence of CHF was 2.99%. Liver stiffness had a significantly positive association with CHF (per 1 unit increase in liver stiffness; odds ratio [OR] = 1.04; 95% confidence interval [CI]: 1.02, 1.05). Multivariate logistic regression showed that each unit increase in liver stiffness raised CHF risk by 7% in participants with low alcohol intake (OR = 1.07; 95% confidence interval: 1.05, 1.09) but not in those with moderate or high alcohol intake. Alcohol consumption showed a significant interaction with liver stiffness (P for interaction = .01). These results were consistent in sensitivity analyses using Firth logistic regression to account for the low event rate. In this cross-sectional analysis based on self-reported CHF and an imbalanced distribution between cases and non-cases, higher liver stiffness was associated with a greater prevalence of CHF, particularly among individuals with low alcohol intake.