Association between non‐alcoholic fatty liver disease and peripheral artery disease in patients with type 2 diabetes

Zou, Yaowu; Li, Xinde; Wang, Can; Wang, Jing; Wang, Fei; Ma, Leina; You, Wenjun; Li, Changgui

doi:10.1111/imj.13549

Cited by 27 publications

(12 citation statements)

References 41 publications

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“… 36,42‐46 Presence of NAFLD was associated with higher prevalence of both coronary heart disease (26.6% vs 18.3%) and cerebrovascular disease (20.0% vs 13.3%), as well as of peripheral arterial disease (15.4% vs 10.0%), in a study of 2839 outpatient T2DM patients 43 . Other groups have reported similar results indicating that NAFLD associated with higher prevalence of markers of advanced atherosclerotic lesions in major arteries, and their clinical manifestations 47‐49 . There is not substantial data yet indicating a preferential location of atherosclerotic lesions in patients with T2DM‐NAFLD.…”

Section: Is Nafld In Type 2 Diabetes Mellitus (T2dm) a Serious Healthmentioning

confidence: 89%

NAFLDin type 2 diabetes mellitus: Still many challenging questions

Cernea,

Raz

2020

Diabetes Metabolism Res

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Summary Epidemiologic data consistently show that in patients with type 2 diabetes (T2DM) the prevalence of non‐alcoholic fatty liver disease (NAFLD), including advanced fibrosis, is double compared to the general population, and it associates with high risk of liver‐related morbidity (advanced fibrosis, hepatocellular carcinoma) and mortality, but also with other systemic consequences, such as cardiovascular (CV) disease, chronic kidney disease, and overall mortality. There are still many answers that need to be clarified regarding NAFLD in T2DM, including deciphering the complex pathogenetic mechanisms, the intertwined relationships with the extrahepatic organs and tissues (mainly heart, kidneys, adipose tissue, gut), the prognostic value of NAFLD for CV risk stratification, and more importantly, what would be the most appropriate screening algorithm, diagnostic method and therapeutic approach. We advocate here for proactive action, in order to identify NAFLD in a timely manner, and suggest a simple algorithm to be used in clinical practice, based on risk stratification and on experts' opinions. We discuss the current therapeutic options for NAFLD in T2DM, for which a multifactorial approach is needed, that concomitantly addresses the liver and the cardio‐reno‐metabolic disturbances.

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Section: Is Nafld In Type 2 Diabetes Mellitus (T2dm) a Serious Healthmentioning

confidence: 89%

NAFLDin type 2 diabetes mellitus: Still many challenging questions

Cernea,

Raz

2020

Diabetes Metabolism Res

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“…Asymptomatic liver fibrosis has been shown to occur in approximately 5.4% of the general population [6]. However, the prevalence of liver disease was found to be much higher (63.0-69.2%) among patients with atherosclerotic vascular diseases [19,20]. Previous reports demonstrated that 23.0-42.7% of stroke patients had NAFLD according to laboratory results or abdominal sonography [9][10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Liver Fibrosis, Not Steatosis, Associates with Long-Term Outcomes in Ischaemic Stroke Patients

et al. 2019

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Background: To investigate whether there are differences in long-term all-cause and cardiovascular mortality according to the burden of liver fibrosis or steatosis in patients with ischaemic stroke or transient ischaemic attack (TIA). Methods: Consecutive patients with acute ischaemic stroke or TIA who underwent transient elastography (TE) from January 2014 to December 2014 were considered eligible. The influence of liver fibrosis or steatosis, assessed via TE, on long-term outcomes was investigated using Cox proportional hazard models. Results: Among 395 patients included in this study, there were 37 (9%) patients with significant fibrosis (> 8.0 kPa) and 164 (41.5%) patients with fatty liver (> 250 dB/m). During the follow-up period (median 2.7 years), all-cause and cardiovascular mortality occurred in 28 (7.1%) and 20 (5.1%) patients. On multivariate analyses, significant liver fibrosis was independently associated with increased risk of all-cause (hazard ratio [HR] 8.14, 95% CI 3.03–21.90, p < 0.001) and cardiovascular (HR 4.29, 95% CI 1.10–16.73, p = 0.036) mortality, whereas fatty liver was not (all p > 0.05). Conclusions: This study found that the burden of liver fibrosis but not that of steatosis, assessed via TE, was an independent predictor of all-cause and cardiovascular mortality during long-term follow-up in patients with ischaemic stroke.

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“…Patients with T2D will worsen the course of NAFLD and, conversely, patients with NAFLD were at higher risk for cardiovascular complications of T2D [49]. In a cross-sectional study on 2,646 T2D patients, patients with NAFLD had significantly higher prevalence of PAD compared with those without NAFLD; this association was much stronger among women than among men [50]. Further studies are needed to screen for hepatic steatosis with/without fibrosis even with non-invasive tests [51].…”

Section: Co-morbiditiesmentioning

confidence: 96%

Risk factors in acute diabetic foot syndrome: analysis of 75 consecutive patients referred to a tertiary center in Modena, Italy

Maurantonio

Gabrielli

Castellano

et al. 2021

Exploration of Medicine

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Aim: Diabetic foot syndrome (DFS) is a complication of diabetes in which the presence of infections, ulceration and/or destruction of deep tissue associated with neuropathy, peripheral atherosclerosis and comorbidity affect the prognosis, the need for limb amputation and quality of life. Purpose of the present study is to report the features of patients with acute DFS admitted to our Diabetic Foot Unit tertiary Center in 2019. Methods: In all patients admitted, the approach was performed through a multidisciplinary team (Diabetic Foot Care Team) and described in a specific diagnostic-therapeutic-assistance program. Criteria of inclusion were presence of sepsis and/or suspected osteomyelitis and/or critical limb ischemia. Clinical features and interventions performed were registered. Primary endpoints were mortality and amputation (major, minor). Secondary endpoints were length of hospitalization, type of revascularization and duration of antibiotic therapy. Results: Among 75 consecutive patients (mean age 70.9 years) enrolled, prevalence of acute DFS was higher among men (M/F 3:1). Poor glycemic control [mean hemoglobin A1c (HbA1c) 67.9 ± 22.3 mmol/mol], long duration of diabetes (mean 19 ± 16.3 years), high low-density lipoprotein-cholesterol (mean 89.5 ± 45.1 mg/ dL) and obesity (mean Body Mass Index 30.2 ± 7.6 kg/m2) were common. Diabetes-related complications as peripheral arterial disease (PAD) (76%), ischemic heart disease (48%), retinopathy (40.5%), hepatic steatosis (50%), heart failure (17.8%) were present. During hospitalization, 21 subjects (28.4%) underwent lower limb amputations (overall rate of major amputation 4%), and 41.3% underwent percutaneous angioplasty. Long period of hospitalization (18.4 ± 7.9 days) and prolonged antibiotic therapy (23.9 ± 15.9 days) were observed. Major amputation was associated with C-reactive protein > 6.5 mg/dL (P = 0.03), osteomyelitis (P = 0.001), prior insulin therapy (P = 0.015). Conclusions: Male sex, co-morbidity, PAD, systemic inflammation and poor glycemic control are major features of acute hospitalized DFS. An approach through a multidisciplinary team is recommended in order to treat vascular and extra-vascular complications aimed at reducing mortality and at improving quality of life.

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Association between non‐alcoholic fatty liver disease and peripheral artery disease in patients with type 2 diabetes

Abstract: Type 2 diabetes patients with NAFLD had a higher prevalence of PAD, and this association was partly, but not entirely, explained by metabolic risk factors and inflammation.

Cited by 27 publications

References 41 publications

NAFLDin type 2 diabetes mellitus: Still many challenging questions

NAFLDin type 2 diabetes mellitus: Still many challenging questions

Liver Fibrosis, Not Steatosis, Associates with Long-Term Outcomes in Ischaemic Stroke Patients

Risk factors in acute diabetic foot syndrome: analysis of 75 consecutive patients referred to a tertiary center in Modena, Italy

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