Clinical research study
Carotid Artery Intima-media Thickness in Nonalcoholic Fatty Liver Disease

https://doi.org/10.1016/j.amjmed.2007.08.041Get rights and content

Abstract

Purpose

To evaluate, in patients with nonalcoholic fatty liver disease with no or mild alterations of liver function tests, carotid artery intima-media thickness and the presence of plaques and to define determinants of vascular damage.

Methods

A paired-sample case-control study: 125 patients with nonalcoholic fatty liver disease and 250 controls, without a prior diagnosis of diabetes, hypertension, and cardiovascular disease, matched for sex, age, and body mass index. B-mode ultrasound was used for evaluation of carotid intima-media thickness and presence of small plaques.

Results

A significant difference in mean values of intima-media thickness (0.89 ± 0.26 and 0.64 ± 0.14 mm, P = .0001) and prevalence of plaques (26 [21%] and 15 [6%], P <.001) was observed in nonalcoholic fatty liver disease patients and controls. Variables significantly associated with intima-media thickness higher than 0.64 mm (median value in controls), in both patients and controls were: age (P = .0001), systolic blood pressure (P = .004), total and low-density lipoprotein cholesterol (P ≤.02 and P = .01, respectively), fasting glucose (P = .0001), and cardiovascular risk (P = .0001) and, only in controls, metabolic syndrome (P = .0001), HOMA-insulin resistance (P = .01), and body mass index (P = .0003). At multivariate logistic regression performed in the overall series of subjects, independent risk predictors of intima-media thickness higher than 0.64 mm were presence of steatosis (odds ratio [OR] = 6.9), age (OR 6.0), and systolic blood pressure (OR 2.3).

Conclusion

Patients with nonalcoholic fatty liver disease, even with no or mild alterations of liver tests, should be considered at high risk for cardiovascular complications.

Section snippets

Patients

We studied 125 consecutive patients with nonalcoholic fatty liver disease (109 males, 16 females, mean age 49 ± 13 years) who presented to our liver unit between June 2002 and December 2004. The diagnosis of nonalcoholic fatty liver disease was based on ultrasonography and confirmed by biopsy in 54 patients. Thirty-four (27%) patients were referred because of abnormalities in liver tests, 16 (13%) for dyslipidemia, 45 (36%) for hyperferritinemia, and 30 (24%) for liver steatosis detected by

Results

The baseline demographic, clinical, and biochemical characteristics of patients with nonalcoholic fatty liver disease and controls are shown in Table 1. HDL cholesterol (40.2 ± 11 vs 50.2 ± 12 mg/100 mL, P ≤.0001), triglycerides (158 ± 96 vs 122 ± 27 mg/100 mL, P ≤.0001), fasting glucose (96.6 ± 19 vs 92.5 ± 13 mg/100 mL, P ≤.01), HOMA-IR (3.8 ± 2.7 vs 2.9 ± 1.7), alanine-aminotransferase (46.6 ± 35 vs 11.6 ± 5.2 UI/L), gamma-glutamyltransferase (58.8 ± 78 vs 25.2 ± 16 UI/L, and cardiovascular risk (FRS, 10 years %)

Discussion

In the present study, we evaluated intima-media thickness and looked for carotid plaques in patients with nonalcoholic fatty liver disease with no or only mild liver function test alterations, and investigated the relationship between vascular damage and metabolic alterations. In our paired-sample case-control study performed in a large series of subjects, we demonstrated that patients with nonalcoholic fatty liver disease, independently of the severity of liver damage, had higher intima-media

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    Supported by grants from FIRST 2004-2005, COFIN 2004, and Ricerca Corrente IRCCS 2004-2005.

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