Nonalcoholic fatty liver disease (NAFLD) is related to risk factors of coronary artery disease, such as dyslipidemia, diabetes, and metabolic syndrome, which are closely linked with visceral adiposity. The aim of this study was to investigate whether NAFLD was associated with coronary artery calcification (CAC), which is used as a surrogate marker for coronary atherosclerosis independent of computed tomography (CT)-measured visceral adiposity. Out of 5,648 subjects who visited one of health screening centers between 2003 and 2008, we enrolled 4,023 (mean age 56.9 ± 9.4 years, 60.7% males) subjects without known liver disease or a history of ischemic heart disease. CAC score was evaluated by the Agatston method. In univariate analyses, the presence of CAC (score >0) was significantly associated with age, sex, body mass index, aspartate aminotransferase, alanine aminotransferase, high-density lipoprotein cholesterol, triglycerides and increased odds of diabetes, hypertension, smoking, and NAFLD. Increasing CAC scores (0, <10, 10-100, ≥100) were associated with higher prevalence of NAFLD (OR 1.84, 95% CI 1.61-2.10, P<0.001). Multivariate ordinal regression analysis adjusted for traditional risk factors, and CT-measured visceral adipose tissue area in a subgroup of subjects showed that the increased CAC scores were significantly associated with the presence of NAFLD (OR 1.28, 95% CI 1.04-1.59, P=0.023) independent of visceral adiposity.
CONCLUSIONS
Patients with NAFLD are at increased risk for coronary atherosclerosis independent of classical coronary risk factors, including visceral adiposity. These data suggest that NAFLD per se might be an independent risk factor for coronary artery disease.
