Hepatic steatosis is associated with an increased risk of carotid atherosclerosis

Abstract

AIM:Although an association between hepatic steatosis and vascular risk factors has been described, direct relationships between fatty liver and atherosclerosis have not yet been investigated. The aim of the present study has been to investigate those relationships. METHODS:The Study of Health in Pomerania examined a random population sample aged between 20 and 79 years. A study population of 4 222 subjects without hepatitis B and C infections and without liver cirrhosis was available for the present analysis. Hepatic steatosis was defined sonographically and intima-media thickness (IMT) as well as plaque prevalence were estimated by carotid ultrasound. RESULTS:The prevalence rate of hepatic steatosis was 29.9%. Among subjects aged ≥45 years, an association between hepatic steatosis and IMT of the carotid arteries was found in bivariate analysis, but not after adjustment for atherosclerotic risk factors. Individuals with fatty liver had more often carotid plaques than persons without fatty liver (plaque prevalence rate 76.8% vs 66.6%; P<0.001).This association persisted after adjustment for confounding factors and was predominantly present in subjects with no to mild alcohol consumption. CONCLUSION:There is an independent association between hepatic steatosis and carotid atherosclerotic plaques. Metabolic changes due to nonalcoholic fatty liver disease may explain this relationship. World

Associations between liver histology and early carotid atherosclerosis in subjects with nonalcoholic fatty liver disease

“…Overall, therefore, the evidence from this and other studies [1][2][3][4] supports the possibility that NAFLD is atherogenic beyond its close relationship to the MetS phenotype, possibly through increased oxidative stress, subclinical inflammation, postprandial lipemia, and decreased adiponectin concentrations. [7][8][9][10] These findings might have important clinical and public health implications.…”

“…3,4 In addition, we found an upregulation of hepatic CB2 receptor but not CB1 receptor expression in a mouse model of CCl 4 -induced hepatic fibrosis (Fig. 1).…”

“…1 These findings confirm and extend the observations of some recent cross-sectional studies documenting that patients with NAFLD, as diagnosed by ultrasonography, had a markedly greater carotid artery intima-media thickness (IMT) and increased prevalence of carotid plaques compared with controls. [2][3][4] More recently, we enrolled 50 consecutive NAFLD patients and 40 healthy controls with normal liver ultrasonography and normal liver enzymes who were matched for sex (M/F 30/20 vs. 26/14), age (46 Ϯ 4 vs. 46 Ϯ 3 years) and BMI (26.6 Ϯ 1.6 vs. 26.2 Ϯ 1.8 kg/m 2 ). The diagnosis of NAFLD was based on liver biopsy and the exclusion of known etiological factors of chronic liver disease.…”

Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: causal effect or epiphenomenon?

“…The main cross-sectional [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] and prospective [11,[32][33][34][35][36][37][38][39][40][41][42][43] studies on the association between NAFLD and intermediate markers of CVDor clinical outcomes are shown in Tables 1 and 2 of the Electronic supplementary material. NAFLD, endothelial dysfunction, early carotid atherosclerosis and left ventricular dysfunction NAFLD is associated with circulatory endothelial dysfunction [16,17], a marker of early atherosclerosis. Compared with non-steatotic controls, non-diabetic patients with NAFLD show a significant decrease in brachial artery flow-mediated vasodilation, which is related to the severity of NAFLD histology, independently of age, sex, BMI and HOMA-IR [16].…”

“…Carotid artery intima-media thickness (IMT), another marker of early atherosclerosis, is also markedly increased in patients with NAFLD patients compared with that in age-, sex-and BMI-matched healthy controls [20][21][22][23][24][25], and NAFLD histology predicts carotid IMT independently of traditional risk factors, HOMA-IR and features of the metabolic syndrome [24]. Similarly, patients with NAFLD, also in the absence of obesity, hypertension and diabetes, exhibit echocardiographic features of early left ventricular dysfunction [18] and impaired energy metabolism as measured by cardiac 31 P magnetic resonance spectroscopy [19].…”