Nonalcoholic fatty liver disease is associated with coronary artery calcification

Abstract

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.

Epicardial fat, cardiac geometry and cardiac function in patients with non-alcoholic fatty liver disease: Association with the severity of liver disease

“…In addition to an expected risk for disease progression from non-alcoholic steatohepatitis (NASH) to bridging fibrosis, cirrhosis and its complications [1], NAFLD patients are also at higher risk of early asymptomatic cardiovascular alterations and/or frank cardiovascular disease [2]. Specifically, NAFLD, diagnosed either by ultrasonography or by liver biopsy, has been associated with a higher prevalence of low coronary flow reserve [3], coronary calcification [4], and carotid atherosclerosis [5][6][7] well-before the occurrence of cardiovascular events. These alterations have been partly associated with the severity of liver damage, measured by both lobular inflammation and fibrosis.…”

Prospective Study of Correlation between Carotid Intimal Medial Thickness and Non Alcoholic Fatty Liver Disease Along with Its Grades

“…In contrast IMT values were found to be significantly higher in diabetic patients regardless of the degree of steatosis by Cakiret al [8] . Similarly other two studies performed in diabetic population reported that hepatic steatosis was not associated with carotid atherosclerosis and suggested that the association of hepatic steatosis and cardiovascular disease might be just an epiphenomenon [9,10] .Targheret al [6] compared carotid IMT in 85 patients with NAFLD and 160 age-, sex-, and BMImatched healthy control subjects and found that the severity Licensed Under Creative Commons Attribution CC BY of liver histopathology in NAFLD patients was strongly associated with early carotid atherosclerosis.. Also Kucukazmanet al [15] in a recent study showed a significant positive correlation between ultrasonographic steatosis grade and mean IMT (r = 0.376, P < 0.001).…”

Nonalcoholic fatty liver disease and cardiovascular risk

“…NAFLD, especially in its necroinflammatory form (NASH), may cause atherogenic dyslipidemia [14] . In addition there is an increase of pro-coagulant factors like fibrinogen, plasminogen activator inhibitor-1 and tumor growth factor, which all increase the risk of atherosclerosis [15] . NAFLD is considered to have chronic sub-clinical inflammation and associated with many inflammatory markers.…”

“…In subjects without calcification at baseline, NAFLD significantly affected the development of calcification after adjusting for traditional metabolic risk factors. The severity of NAFLD was dose-dependently associated with the development of CAC Kim et al [15] (2012) Retrospective chart review-4 023 subjects (mean age, 56.9 ± 9.4 yr; 60.7% males) without known liver disease or a history of ischemic heart disease Calcium scoring CT to assess CAC Ultrasound Patients with NAFLD are at increased risk for coronary atherosclerosis independent of classical coronary risk factors, including visceral adiposity.…”