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Alcoholic and non-alcoholic fatty liver disease and associations with coronary artery calcification: evidence from the Kangbuk Samsung Health Study
  1. Yoosoo Chang1,2,3,
  2. Seungho Ryu1,2,3,
  3. Ki-Chul Sung4,
  4. Yong Kyun Cho5,
  5. Eunju Sung6,
  6. Han-Na Kim7,
  7. Hyun-Suk Jung1,
  8. Kyung Eun Yun1,
  9. Jiin Ahn1,
  10. Hocheol Shin1,6,
  11. Sarah Helen Wild8,
  12. Christopher D Byrne9,10
  1. 1Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
  2. 2Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
  3. 3Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
  4. 4Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
  5. 5Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
  6. 6Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Jongno-gu, Seoul, The Republic of Korea
  7. 7Medical Research Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
  8. 8Usher Institute of Population Health Sciences and informatics, University of Edinburgh, Edinburgh, UK
  9. 9Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK
  10. 10National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
  1. Correspondence to Dr Seungho Ryu, Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; sh703.yoo{at}samsung.com

Abstract

Objective Recent evidence suggests that alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD) may differentially affect risk of cardiovascular mortality. To investigate whether early liver disease due to AFLD or NAFLD have similar or dissimilar effects on risk of early coronary artery atherosclerosis, we have investigated the associations between AFLD and NAFLD and coronary artery calcium (CAC).

Design A cross-sectional study was performed in 105 328 Korean adults who attended a health check-up programme. CAC score was assessed using CT, daily alcohol intake was recorded as grams/day and liver fat by ultrasound. Logistic regression model was used to calculate ORs with 95% CIs for prevalent CAC.

Results Both NAFLD and AFLD were positively associated with CAC score. After adjusting for potential confounders, multivariable-adjusted OR (95% CIs) for CAC >0 comparing NAFLD and AFLD to the reference (absence of both excessive alcohol use and fatty liver disease) were 1.10 (95% CI 1.05 to 1.16) and 1.20 (95% CI 1.11 to 1.30), respectively. In post hoc analysis, OR (95% CI) for detectable CAC comparing AFLD to NAFLD was 1.09 (95% CI 1.01 to 1.17). Associations of NAFLD and AFLD with CAC scores were similar in both non-obese and obese individuals without significant interaction by obesity (p for interaction=0.088). After adjusting for homeostasis model assessment of insulin resistance and high-sensitivity C reactive protein, the associations between fatty liver disease and CAC scores remained statistically significant.

Conclusion In this large sample of young and middle-aged individuals, early liver disease due to NAFLD and AFLD were both significantly associated with the presence of coronary artery calcification.

  • alcoholic liver disease
  • fatty liver
  • nonalcoholic steatohepatitis
  • cardiovascular disease

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Footnotes

  • Contributors YC: study concept and design; acquisition of data; interpretation of data; drafting of the manuscript; and critical revision of the manuscript. SR: study concept and design; acquisition of data; analysis and interpretation of data; and critical revision of the manuscript. K-CS and SHW: interpretation of data smf and critical revision of the manuscript. YKC and HS: technical or material support; critical revision of the manuscript; and study supervision. ES: technical or material support; interpretation of data; and study supervision. H-NK,H-SJ, KEY and JA: acquisition of data; interpretation of data; and critical revision of the manuscript. CDB: study concept and design; interpretation of data; and critical revision of the manuscript.

  • Funding This study was supported by the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future (S20170622000) and by the MRC-KHIDI UK-KOREA PARTNERING AWARD (Medical Research CouncilMC_PC_16016).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Institutional Review Board of Kangbuk Samsung Hospital (IRB No. KBSMC 2018-01-018), which waived the requirement for informed consent as only de-identified data obtained as part of routine health screening exams were used.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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