Fatty Liver, Insulin Resistance, and Features of Metabolic Syndrome

Abstract

OBJECTIVENonalcoholic fatty liver disease (NAFLD) coexists with insulin resistance (IR), but it is uncertain whether NAFLD and IR contribute independently to atherosclerosis. We tested whether fatty liver, IR, and metabolic syndrome (MetS) features (waist, glucose, triglyceride, HDL cholesterol [HDL-C], and blood pressure) were associated with a marker of atherosclerosis (coronary artery calcium [CAC] score >0), independently of cardiovascular risk factors and cardiovascular disease (CVD).RESEARCH DESIGN AND METHODSData were analyzed from a South Korean occupational cohort of 10,153 people who all received ultrasound measurements of fatty liver and a cardiac computed tomography CAC score. IR was defined by homeostasis model assessment of IR (HOMA-IR) ≥75th percentile. Odds ratios (ORs) (95% CIs) for the presence of a CAC score >0 were estimated using logistic regression.RESULTSThere were 915 people with a CAC score >0. MetS features were increased (glucose, blood pressure, triglyceride, and waist) or decreased (HDL-C) among people with a CAC score >0 (all comparisons against CAC score ≤0; P < 0.0001). Of subjects with a CAC score >0, 55% had fatty liver and 33.7% were insulin resistant. Fatty liver (OR 1.21 [95% CI 1.01–1.45]; P = 0.04) and HOMA-IR (1.10 [1.02–1.18]; P = 0.02) were associated with CAC score >0, independently of all MetS features, conventional cardiovascular risk factors, and prior evidence of CVD. The presence of IR and fatty liver combined was associated with CAC score >0 (1.53 [1.20–1.95]; P = 0.001).CONCLUSIONSFatty liver and HOMA-IR are both associated with a CAC score >0 (independently of each other), features of MetS, conventional cardiovascular risk factors, and existing CVD.

Fatty liver largely explains associations of subclinical hypothyroidism with insulin resistance, metabolic syndrome, and subclinical coronary atherosclerosis

“…In another study using euglycemic hyperinsulinemic clamps, Fabbrini et al (37) found a significantly greater insulin resistance in liver, adipose, and muscle tissues from obese subjects with NAFLD compared with that observed in obese subjects without NAFLD, even though the two groups had been matched for VAT volume. With regard to the association between FL and CAC score O0, two recent studies involving large numbers of subjects showed that the association remained significant after controlling for traditional cardiovascular risk factors, including VAT (38) or pre-existing cardiovascular disease (39). Taken together, our results and those of other studies (36,37,38,39) strongly suggested that hepatic fat is intimately involved in the pathogenesis of metabolic abnormalities and subclinical atherosclerosis present in subjects with FL.…”

“…With regard to the association between FL and CAC score O0, two recent studies involving large numbers of subjects showed that the association remained significant after controlling for traditional cardiovascular risk factors, including VAT (38) or pre-existing cardiovascular disease (39). Taken together, our results and those of other studies (36,37,38,39) strongly suggested that hepatic fat is intimately involved in the pathogenesis of metabolic abnormalities and subclinical atherosclerosis present in subjects with FL. The adverse cardiovascular risk profile found in subjects with SCH plus FL may serve as a marker of long-term cardiovascular risk and may explain some of the previously observed associations between SCH and cardiovascular disease (10,33).…”

Correlation of non alcoholic fatty liver disease in patients of coronary artery disease

“…[15][16][17] The present study showed that the prevalence of NAFLD was highest in more than 40 years age group & in males. The findings of the study is in line with the Kalra et al study where the prevalence was the highest in 60-70 year age group.…”

Stabilization of high-risk plaques

“…Even in the absence of DM, higher blood glucose levels, higher hemoglobin A1c levels, and insulin resistance (IR) have been shown to be associated with an increased risk of ASCVDs (87)(88)(89). IR plays crucial roles in atherosclerosis (90), and it has been clarified that IR was positively associated with coronary severity (91), the coronary calcium score (92), and a remodeling index (93). Various past studies in basic research have supported the results of these clinical trials.…”