Cardiovascular risk in patients with nonalcoholic fatty liver disease: looking at the liver to shield the heart

Cusi, Kenneth; Leiva, Eddison Godinez

doi:10.1097/mol.0000000000000717

Cited by 11 publications

(12 citation statements)

References 20 publications

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“…On the other hand, although restricted to ultrasound-based liver appearance to screen for hepatic fatty infiltration, this is the dominant screening tool for NAFLD worldwide, due to its low cost, safety and accessibility 32 . Furthermore, although insufficient for a diagnosis of NAFLD, the higher ALT levels and, consequently, lower AST/ALT ratio in the firefighters with fatty liver corroborate previous studies 29 , 32 . A prospective study of 400 US military personnel and their relatives (mean age 55 years) estimated the prevalence of NAFLD by ultrasound, further confirmed by liver biopsy, to be as high as 46%.…”

Section: Discussionsupporting

confidence: 88%

“…For example, there is a significant role of SHBG gene polymorphisms on the levels of SHBG independently of obesity, fatty liver and testosterone. Also, the degree of inflammation, distribution of adiposity and the energetic efficiency of the different adipose tissue deposits have been studied as determinants of both NAFLD and testosterone insufficiency, beyond obesity per se 29 .…”

Section: Discussionmentioning

confidence: 99%

“…In this context, an independent role of NAFLD in CV health remains underexplored, despite of increasing evidence of the occurrence of common pathogenic mechanisms [24][25][26][27][28] . Several integrating processes linking NAFLD to the complex network of cardiometabolic factors have been proposed, including low-grade inflammation due to increased secretion of deleterious hepatokines, hyperinsulinemia and hyperglycemia, atherogenic dyslipidemia, endothelial disfunction and thrombogenesis 29 . However, to our knowledge, there is no previous study on the prevalence of NAFLD in firefighters, which is remarkable considering the high prevalence of traditional CV risk factors among these men 17,18,21,22 .…”

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confidence: 99%

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Low testosterone and cardiometabolic risks in a real-world study of US male firefighters

Lofrano‐Porto

Soares

Eagan

et al. 2021

Sci Rep

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Low serum total testosterone (TT) is associated with increased cardiovascular risk and metabolic derangements, with fatty liver (FL) emerging as an additional cardiometabolic threat. We investigated the associations between TT and cardiometabolic (CM) health in 298 US male firefighters. Cross-sectional data from occupational health examination were analyzed. TT was categorized as low (< 264 ng/dL), borderline (264–399 ng/dL), and reference (400–916 ng/dL). Conventional CM risk factors were compared among TT categories, and between firefighters with and without FL. 81% of firefighters were obese/overweight; almost 40% had FL. In the low-TT group, only 3.1% had normal BMI, while 78.1% had FL. The low-TT group had a worse CM profile, independently of age and BMI, and a fourfold higher adjusted odds of having FL. FL was associated with lower TT, regardless of age, BMI and HbA1c. Having a FL, HbA1c ≥ 5.7% or triglycerides ≥ 150 mg/dL increased the odds for low-TT by 4.1, 2.7 and 6.6 times, respectively. These real-world data reveal strong associations between low-TT and CM risk factors and support a call for action towards screening for low-TT and FL, regardless of age, BMI or dysmetabolic conditions in firefighters. Recognizing cardiometabolic risks in firefighters provides an opportunity to lessen cardiovascular diseases burden.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Low testosterone and cardiometabolic risks in a real-world study of US male firefighters

Lofrano‐Porto

Soares

Eagan

et al. 2021

Sci Rep

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“…Optimal care of the growing population of patients with NAFLD and NASH requires clinicians from different specialties, including primary care, gastroenterology, hepatology, obesity management, and endocrinology, to co-manage the hepatic manifestations of the disease, as well as the comorbid metabolic traits and cardiovascular risk. 11 Such a process could benefit from an algorithmic approach to NAFLD screening, diagnosis, and risk stratification. 12 Clinical care pathways have been found to improve the quality of health care delivery in other areas of medicine.…”

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confidence: 99%

Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease

et al. 2021

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“…Patients with NASH are also at a higher risk of hepatocellular carcinoma ( 6 , 7 ). Finally, the risk of CVD is also much higher and is the leading cause of death ( 11 ).…”

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confidence: 99%

The Emerging Role of Glucagon-like Peptide-1 Receptor Agonists for the Management of NAFLD

Chavez

Cusi

Kadiyala

2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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105

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Context The burden of cirrhosis from NAFLD is reaching epidemic proportions in the United States. This calls for greater awareness among endocrinologists, who often see but may miss the diagnosis in adults with obesity or type 2 diabetes mellitus (T2D) who are at the highest risk. At the same time, recent studies suggest that GLP-1RAs are beneficial versus steatohepatitis (NASH) in this population. This minireview aims to assist endocrinologists to recognize the condition and recent work on the role of GLP-1RAs in NAFLD/NASH. Evidence acquisition Evidence from observational studies, randomized controlled trials, and meta-analyses. Evidence Synthesis Endocrinologists should lead multidisciplinary teams to implement recent consensus statements on NAFLD that call for screening and treatment of clinically significant fibrosis to prevent cirrhosis, especially in the high-risk groups (i.e., people with obesity, prediabetes or T2D). With no FDA-approved agents, weight loss is central to their successful management, with pharmacological treatment options limited today to vitamin E (in people without T2D) and diabetes medications that reverse steatohepatitis, such as pioglitazone or GLP-1RA. Recently the benefit of GLP-1RAs in NAFLD, suggested from earlier trials, has been confirmed in adults with biopsy-proven NASH. In 2021, the FDA also approved semaglutide for obesity management. Conclusion A paradigm change is developing between the endocrinologist’s greater awareness about their critical role to curve the epidemic of NAFLD and new clinical care pathways that include a broader use of GLP-1RAs in the management of these complex patients.

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Cardiovascular risk in patients with nonalcoholic fatty liver disease: looking at the liver to shield the heart

Cited by 11 publications

References 20 publications

Low testosterone and cardiometabolic risks in a real-world study of US male firefighters

Low testosterone and cardiometabolic risks in a real-world study of US male firefighters

Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease

The Emerging Role of Glucagon-like Peptide-1 Receptor Agonists for the Management of NAFLD

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