Persistent Nonalcoholic Fatty Liver Disease Increases Risk for Carotid Atherosclerosis

doi:10.1053/j.gastro.2016.06.001

Gastroenterology

Volume 151, Issue 3, September 2016, Pages 481-488.e1

https://doi.org/10.1053/j.gastro.2016.06.001 Get rights and content

Background & Aims

Nonalcoholic fatty liver disease (NAFLD) has been associated with subclinical atherosclerosis in cross-sectional studies. We investigated the longitudinal association of NAFLD with the development of subclinical carotid atherosclerosis.

Methods

We performed a retrospective cohort study of 8020 adult men (average age, 49.2 y) without carotid atherosclerosis at baseline who underwent repeated health check-up examinations from January 1, 2005, through December 31, 2013. NAFLD status was diagnosed by ultrasonography and classified into 4 groups based on baseline and follow-up findings: none, developed, regressed, or persistent NAFLD. Subclinical carotid atherosclerosis was measured by ultrasound.

Results

The age-adjusted hazard ratio for subclinical carotid atherosclerosis development comparing participants with persistent NAFLD with those without NAFLD was 1.23 (95% confidence interval [CI], 1.13–1.35; P < .001). The association persisted after adjustment for smoking, alcohol, body mass index, and weight change (hazard ratio, 1.13; 95% CI, 1.03–1.25; P = .014), but disappeared after adjustment for metabolic variables. The hazard ratio, comparing subjects with regression of NAFLD vs those with persistent NAFLD, was 0.82 (95% CI, 0.69–0.96; P = .013). The risk of subclinical carotid atherosclerosis development also was higher among participants with a high NAFLD fibrosis score, fibrosis-4 scores, or levels of γ-glutamyl transferase at baseline.

Conclusions

In a large cohort study, persistent NAFLD was associated with an increased risk of subclinical carotid atherosclerosis development. This association was explained by metabolic factors that could be potential mediators of the effect of NAFLD. Markers of liver fibrosis also were associated with subclinical carotid atherosclerosis development. Prospective studies are needed to determine whether treatment of NAFLD can reduce this risk.

Section snippets

Study Population

We conducted a retrospective cohort study based on the population of men aged 20 years or older who underwent a comprehensive health check-up examination including abdominal and carotid ultrasound at Samsung Medical Center’s Health Screening Center in Seoul, South Korea, between January 1, 2005, and December 31, 2013 (Figure 1). Because our objective was to evaluate the association between NAFLD status and the risk of developing subclinical carotid atherosclerosis, the analysis was restricted

Results

The mean age of study participants was 49.2 years (SD, 7.1 y) (Table 1). The prevalence of diabetes, hypertension, dyslipidemia, and smoking at baseline were 5.8%, 21.8%, 41.6%, and 56.9%, respectively. The prevalence of NAFLD at baseline was 39.7% (n = 3185), and, of those, 17.6% (562 of 3185) showed regression of NAFLD by the end of the follow-up evaluation. Among 4835 participants without NAFLD at baseline, 23.1% (1118 of 4835) developed NAFLD by the end of the follow-up evaluation.

The

Discussion

In this large cohort study with longitudinal assessment of the association between NAFLD status and the risk of carotid atherosclerosis, we found that participants with persistent NAFLD were at higher risk of subclinical carotid atherosclerosis development compared with those without NAFLD. This association was mediated by metabolic risk factors. Furthermore, among participants with NAFLD at baseline, regression of NAFLD over follow-up evaluation was associated with a reduced risk of

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: Conflicts of interest The authors disclose no conflicts.

^∗: Authors share co-first authorship.

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Original ResearchFull Report: Clinical—LiverPersistent Nonalcoholic Fatty Liver Disease Increases Risk for Carotid Atherosclerosis

Background & Aims

Methods

Results

Conclusions

Section snippets

Study Population

Results

Discussion

Gastroenterology

J Hepatol

Atherosclerosis

J Am Soc Echocardiogr

J Hepatol

Atherosclerosis

J Hepatol

Atherosclerosis

J Hepatol

Atherosclerosis

Atherosclerosis

J Hepatol

KASL clinical practice guidelines: management of nonalcoholic fatty liver disease

Clin Mol Hepatol

Human fatty liver disease: old questions and new insights

Science

Fatty liver, insulin resistance, and features of metabolic syndrome: relationships with coronary artery calcium in 10,153 people

Diabetes Care

Relation of nonalcoholic hepatic steatosis to early carotid atherosclerosis in healthy men: role of visceral fat accumulation

Diabetes Care

Fatty liver index, gamma-glutamyltransferase, and early carotid plaques

Hepatology

Usefulness of ultrasonographic markers of carotid atherosclerosis (intima-media thickness, unstable carotid plaques and severe carotid stenosis) for predicting presence and extent of coronary artery disease

J Cardiovasc Med (Hagerstown)

Original Research
Full Report: Clinical—Liver
Persistent Nonalcoholic Fatty Liver Disease Increases Risk for Carotid Atherosclerosis