Association between the Severity of Nonalcoholic Fatty Liver Disease and the Risk of Coronary Artery Calcification

Abstract

Background and Objectives: There are limited data on the association between severity of non-alcoholic fatty liver disease (NAFLD) and coronary artery calcification. This study investigated sonographic diagnosed NAFLD and coronary artery calcium score (CAC) as detected by cardiac multidetector computed tomography in general populations. Materials and Methods: A total of 545 patients were enrolled in this study. NAFLD was diagnosed by ultrasonography examination and CAC score were evaluated by cardiac multidetector computed tomography. The association between NAFLD and artery calcium score stage was determined by logistic regression analysis and Spearman correlation coefficient analysis. Results: Of all the participants, 437 (80.2%) had ultrasonography-diagnosed NAFLD and 242 (44%) had coronary artery calcification (CAC > 0). After adjustment for cardiovascular risk factors, the risk of developing coronary artery calcification was 1.36-fold greater in the patients with different severity of NAFLD compared to those without NAFLD (OR = 1.36, 95% CI = 1.07–1.77, p = 0.016). The highest OR for separate coronary artery calcification was 1.98 (OR = 1.98, 95% CI = 1.37–2.87, p < 0.001) in the left main artery, and the risk was still 1.71-fold greater after adjustments (OR = 1.71, 95% CI = 1.16–2.54, p = 0.007). Conclusions: This cross-sectional study demonstrated that the severity of NAFLD was associated with the presence of significant coronary artery calcification, especially in the left main coronary artery, suggesting increasing the cardiovascular risk.

Systematic review with meta‐analysis: Steatosis severity and subclinical atherosclerosis in metabolic dysfunction‐associated steatotic liver disease

“…28,30 The remaining 12 studies leveraged US to gauge the steatosis gra des. 16,[18][19][20][21][22][23]25,26,29,32,33 The assessment of subclinical atherosclerosis witnessed varied approaches within the included studies. Four studies harnessed IMT scores to evaluate atherosclerosis, 29,30,32,33 whereas three opted for Brachial-ankle pulse wave velocity (BaPWV), 17,23,34 one study employed augmentation index at 75 beats per minute (AI@75) for this purpose, 24 another used cardio-ankle vascular index (CAVI) 27 and the remaining 10 used CAC.…”

“…Four studies harnessed IMT scores to evaluate atherosclerosis, 29,30,32,33 whereas three opted for Brachial-ankle pulse wave velocity (BaPWV), 17,23,34 one study employed augmentation index at 75 beats per minute (AI@75) for this purpose, 24 another used cardio-ankle vascular index (CAVI) 27 and the remaining 10 used CAC. 16,[18][19][20][21][22]25,26,28,31…”

“…In 15 studies, the reference group for patients with mild steatosis comprised individuals with no steatosis, while for patients with moderate to severe steatosis, the reference group was also no steatosis in those same 15 studies. 16,[18][19][20][21][22][23][25][26][27]29,[31][32][33][34] Additionally, for moderate to severe steatosis, 4 studies used mild steatosis as the reference group. 17,24,28,30…”

“…[16][17][18]21,23,25,26,[30][31][32] Additionally, nine studies provided unadjusted ORs, indicating the association between the variables without accounting for potential confounders. 19,20,22,24,[27][28][29]33,34…”

New Insights into Non-Alcoholic Fatty Liver Disease and Coronary Artery Disease: The Liver-Heart Axis

“…NAFLD not only promotes atherosclerosis, but also predisposes to the evolution towards coronary artery disease (CAD), valvular heart disease, left ventricular dysfunction, heart failure, arrhythmia, and stroke [ 22 , 23 ]. A longer duration and the progression to advanced stages of NAFLD are associated with an increased cardiovascular risk, including coronary lesions [ 24 , 25 ], high arterial stiffness [ 26 ], impaired endothelial function, or a greater risk for carotid intima-media thickening [ 27 ].…”