Introduction NAFLD, which is increasingly and rapidly becoming the cause of liver disease in Western countries, is characterised by higher serum triglyceride and LDL levels, lower HDL levels, insulin resistance, and glucose intolerance, all crucial risk factors for the development of atherogenesis. The UK Prospective Diabetes Study (UKPDS risk engine v 2.0) and the Fatty liver index (FLI) are both validated prognostic scores for cardiovascular disease (CVD) risk and NAFLD in diabetic patients.
Methods We retrospectively analysed 1902 patients attending our Diabetes Ambulatory in 2012–2013. The UKPDS risk engine and the FLI were calculated for each of these patient. Ninety-nine (19.2%) of these patients resulted at high CVD risk according to their UKPDS evaluation and underwent a complete CVD assessment (ergometric/ecostress test (EET), coronarography (CORO)). A two tailed t-test, Person’s Chi square test, and analysis of variance (ANOVA) were carried out.
Results Sixty-six (59 M, mean age 68.1 y, mean disease duration 16.1 y, HbA1c > 7 prevalent) pts presented UKPDS positive/FLI > 60, 8/66 CORO+ (5 percutaneous transluminal coronary angiopathy-PTA, 3 cardiac bypass sugery-CABG, 1 peripheral transluminal angioplasty-PTA AAII) and 5 (4 M, mean age 68.6 y, mean duration disease 18.4 y, HbA1c > 7 prevalent) pts presented UKPDS positive/FLI < 20,1/5 CORO+ (1 PTCA; 1 CABG; 0 PTA, AII). In the light of this analysis, were able to pinpoint a FLI cutoff that is better able to identify, with respect to UKPDS, patients who will result positive at CORO (FLI > 52 detected 9/14 pts positive at CORO with p < 0.05). Ninety-nine pts UKPDS positive(EET negative 69.6% > 69/99) (100% > 14/14 CORO+) vs 81 pts FLI > 52 (EET negative 92.5% > 75/81) (64.2% > 9/14 CORO+). As expected, we found a significant association between CORO+ and FLI+ patients and microalbuminuria (p < 0.048), cholesterol (p < 0.020); triglycerides (p < 0.001), and LDL (p < 0.005). The only drug associated to CV risk was cardioaspirn (p < 0.003).
Conclusion Study results demonstrate that FLI can be used as a marker to predict CVD risk in patients with FLI > 52. The number of patients who undergo CVD screening with a low percentage of positivity can thus be reduced. An early and aggressive treatment and monitoring program can instead be begun for type 2 diabetic patients with FLI > 52 and a reasonable suspicion of NAFLD because this population has higher risk of developing CVD events with respect to patients with FLI < 20.
Disclosure of Interest None Declared
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