Nonalcoholic fatty liver disease contributes to subclinical atherosclerosis: A systematic review and meta‐analysis

Abstract

Nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of atherosclerotic cardiovascular disease. In our meta‐analysis, we aimed to assess the correlation of NAFLD and four surrogate markers of subclinical atherosclerosis. PubMed, Embase, and the Cochrane Library were searched up until April 2017. Original studies investigating the association between NAFLD and subclinical atherosclerosis were included. The outcome data were extracted and pooled for the effect estimate by using a random‐effects model. We used the Newcastle‐Ottawa Quality Assessment Scale to assess the quality of the included studies. Of the 434 initially retrieved studies, 26 studies involving a total of 85,395 participants (including 29,493 patients with NAFLD) were included in this meta‐analysis. The Newcastle‐Ottawa Quality Assessment Scale scores suggested the included studies were of high quality. The pooled effects estimate showed that subjects with NAFLD exhibited a significant independent association with subclinical atherosclerosis compared to the non‐NAFLD group (odds ratio, 1.60; 95% confidence interval, 1.45‐1.78). Subgroup analysis suggested that the presence of NAFLD yielded a remarkable higher risk of increased carotid artery intima‐media thickness/plaques, arterial stiffness, coronary artery calcification, and endothelial dysfunction with odds ratios (95% confidence interval) of 1.74 (1.47‐2.06), 1.56 (1.24‐1.96), 1.40 (1.22‐1.60), and 3.73 (0.99‐14.09), respectively. Conclusion: Our meta‐analysis revealed a close link between NAFLD and subclinical atherosclerosis in light of four different indices. Patients with NAFLD might benefit from screening and surveillance of early atherosclerosis, which would facilitate the prediction of potential cardiovascular disease burden, risk stratification, and appropriate intervention in the long term. (Hepatology Communications 2018;2:376‐392)

NAFLD and increased risk of cardiovascular disease: clinical associations, pathophysiological mechanisms and pharmacological implications

“…Strong evidence links NAFLD with objectively assessed subclinical atherosclerosis (including also increased coronary artery calcium score) in adults and adolescents, as well as with an increased prevalence of clinically manifest CVD both in the general population and in different patient groups [11,12,13]. Recently, in a large cohort of South Korean individuals without pre-existing CVD, Lee et al also showed that imaging-defined NAFLD was independently associated with a higher risk of having non-calcified, "vulnerable" coronary atherosclerotic plaques (as detected by coronary computed tomography angiography), thereby highlighting an increased NAFLD-related CVD risk among these asymptomatic individuals [14].…”

Pathogenesis of Insulin Resistance and Atherogenic Dyslipidemia in Nonalcoholic Fatty Liver Disease

“…7 | 362-370 99 A plethora of studies report an association between NAFLD and these markers of preclinical atherosclerosis, with multiple systematic reviews and meta-analyses highlighting the association between NAFLD and carotid-artery intimamedia-thickness, coronary artery calcification and endothelial dysfunction, independent of traditional risk factors. [100][101][102][103] A recent systematic review and meta-analysis by Zhou et al 100 examining 26 observational studies further validated that the presence of NAFLD predisposes to a significantly higher risk of increased carotid artery intima-media thickness/plaques, arterial stiffness, coronary artery calcification and endothelial dysfunction, with odds ratios (95% confidence intervals) of 1.74 (1.47-2.06), 1.56 (1.24-1.96), 1.4 (1.22-1.60), and 3.73 (0.99-14.09) respectively. Casecontrol studies have also reported strong associations of NAFLD with early changes in left ventricular morphology and/or diastolic dysfunction with insulin resistance a likely key contributor.…”

Hepatic fat: Pathogenic trigger or passenger?

“…18,19 Amongst 7,196 individuals free of CVD, NAFLD presence and severity was associated with aortic stiffness beyond abdominal obesity 20 and with subclinical atherosclerosis; increased carotid artery intima-media thickness/plaques, arterial stiffness, coronary artery calcification, and endothelial dysfunction. 21 The presence and amount of steatosis was also recently related with impaired cardiac and autonomic function when compared with controls. 22 However, it is difficult to separate the effect of reduced insulin sensitivity from the direct effect of NAFLD on CVD risk.…”