Coronary artery disease, hepatic steatosis linked in asymptomatic patients

ORLANDO, Fla. — Hepatic steatosis and coronary artery disease are each independently and strongly predictive of one another, according to data presented at Digestive Disease Week.

Researchers assessed upper abdominal CT images from 377 asymptomatic volunteers undergoing noncontrast CT to determine coronary calcium scores (CCS). The presence of hepatic steatosis and/or metabolic syndrome was determined in each case, and a blood sample was collected to determine liver chemistry, lipid profile and hepatitis B or C exposure. A CCS greater than 100 was defined as coronary artery disease (CAD).

“It appears that fatty liver disease is an independent risk factor for cardiovascular disease, and in our asymptomatic volunteer patients, it was a more significant risk factor than all of the traditional cardiovascular risk factors,” researcher John H. Helzberg, MD, gastroenterologist at St. Luke’s Hospital in Kansas City, Mo., told Healio.com. “[Also,] coronary disease was actually a predictor for fatty liver disease; this may have some significance for patients undergoing high-risk cardiac surgery or cardiac transplant.”

Hepatic steatosis was independently associated with risk for CAD (OR=2.85; 95% CI, 1.26-6.44). This risk increase was greater than any other evaluated risk factors, including advanced age, male sex, smoking, hypertension, diabetes, LDL cholesterol and metabolic syndrome. The addition of hepatic steatosis to a traditional Framingham model did not significantly increase the c-statistic (0.776 compared with 0.789; P=.31), but did result in a significant integrated discrimination improvement value (absolute IDI=0.17, relative IDI=13.6%; P=.045).

Investigators also noted an independent association between CAD and risk for hepatic steatosis (OR=2.45; 95% CI, 1.08-5.54), which was stronger than that observed between CAD and diabetes, metabolic syndrome and elevated BMI.

Researcher Rajiv Chhabra, MD, assistant professor at the University of Missouri-Kansas City School of Medicine, told Healio.com that patients with coronary disease should be screened for advanced liver disease, and called for more research into an association between CAD and hepatic steatosis. “This [study] definitely suggests a relation, but doesn’t establish any causal relationship; there definitely should be more trials to see, among patients who have fatty liver disease [who] get better through exercise, diet or medication, whether their heart disease risk also goes down.”

Disclosure: Researcher Randall C. Thompson, MD, has performed speaking and teaching services for Astellas Pharma. Researcher James H. O’Keefe, MD, has performed speaking and teaching services for AstraZeneca, Boehringer Ingelheim GmbH, Forest Laboratories and GlaxoSmithKline.

For more information:

Chhabra R. #380: Hepatic Steatosis Is an Independent and a Strong Predictor of Coronary Artery Disease in Asymptomatic Patients, Beyond That Expected From Conventional Framingham Risk Factors and Metabolic Syndrome. Presented at: Digestive Disease Week 2013; May 18-21, Orlando, Fla.