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Systemic endothelial dysfunction common, cardiovascular risk high in cirrhotic patients

Patients with cirrhosis are prone to systemic endothelial dysfunction and elevated risk for cardiovascular events, and the presence of cardiovascular risk factors decreases vascular reactivity, according to recent results.

Researchers evaluated risk for cardiovascular events, hepatic and systemic hemodynamics and the presence of carotid plaques in 47 adult patients with cirrhosis. Flow-mediated dilation (FMD) of the brachial artery via ultrasound was performed as a noninvasive method of assessing systemic endothelial dysfunction (defined as FMD values less than 10%).

Slightly more than half of the cohort were considered at low or moderate risk for a cardiovascular event (25.5% for each), while 40.4% were at moderately high and 8.6% were at high risk, based on a calculated 10-year risk and the presence of potential risk factors. The most commonly observed cardiovascular risk factors (CVRF) included elevated BMI (47% of patients), smoking (40%), family history for cardiovascular disease (26%) and diabetes (23%).

The mean FMD value for the cohort was 10.9 ± 6.9%. FMD values increased parallel to worsening liver function, with significant correlations observed between FMD and factors including serum sodium levels (P<.0001), bilirubin levels (P=.019), plasma renin activity (P=.001) and leukocyte (P=.001) and platelet counts (P=.01). Systemic endothelial dysfunction was present in more than half (53.1%) of participants, with prevalence increasing parallel to cardiovascular risk (75% in high-risk cases vs. 16.6% in the low-risk group, P=.039).

Multivariate analysis indicated significant associations between systemic endothelial dysfunction and bilirubin levels (OR=0.33, 0.09-0.91), leukocyte count (OR=0.02, 0.001-0.40) and elevated cardiovascular risk (OR=49.4, 2.5-152.0 for high risk, OR=35.9, 2.1-98.1 for moderately high and OR=6.15, 1.3-68.2 for moderate risk) (95% CI for all).

Additional analysis including the presence or absence of carotid plaques instead of cardiovascular risk status indicated that bilirubin and leukocytes were protective against endothelial dysfunction (OR=0.29, 0.10-0.83, bilirubin; OR=0.07, 0.009-0.55, leukocytes) while elevated BMI increased risk (OR=4.33, 1.02-25.5, overweight; OR=35.9, 1.06-74.1, obesity) (95% CI for all).

“Our findings suggest that systemic vascular reactivity in cirrhosis is influenced by a dual mechanism: It is up-regulated by liver failure and portal hypertension, while the presence of CVRF determines a decreased vascular reactivity, which is relevant in this population,” the researchers wrote. “The confounding effect of liver-related variables on FMD suggests that, contrary to the general population, this research tool cannot be used to predict the global cardiovascular risk in patients with cirrhosis.”