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Persistent NAFLD increases risk for subclinical carotid atherosclerosis

New findings from a retrospective study showed patients with persistent nonalcoholic fatty liver disease were at an increased risk for developing subclinical carotid atherosclerosis.

“NAFLD is associated with metabolic syndrome, diabetes and cardiovascular disease morbidity and mortality, indicating that NAFLD is a multisystem disease closely linked to metabolic disease and atherosclerotic [cardiovascular disease],” Geum-Youn Gwak, MD, PhD, of the department of medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea, and colleagues wrote.

They analyzed data from 8,020 adult men without carotid atherosclerosis who underwent multiple health examinations at Samsung Medical Center’s Health Screening Center in Seoul, South Korea, between January 2005 and December 2013. All men completed self-administered health questionnaires and underwent extensive physical examination. Researchers used ultrasonography to measure NAFLD and classified patients into four groups based on baseline and follow-up findings: no NAFLD, developed NAFLD, regressed NAFLD or persistent NAFLD.

Subclinical carotid atherosclerosis was defined as a patient developing an abnormally increased carotid intima-media thickness or evidence of carotid plaque — popular markers of subclinical atherosclerosis that predict cardiovascular disease — and measured via ultrasound.

During a median 3.3-year follow-up, 2,523 patients developed subclinical carotid atherosclerosis, with a 3-year cumulative incidence of 14.3%. The 3-year cumulative incidences of subclinical carotid atherosclerosis were 13.6% in patients without NAFLD, 12.2% in patients with developed NAFLD, 11.4% in patients with regressed NAFLD and 16.8% in patients with persistent NAFLD.

In a multivariate-adjusted analysis, the age-adjusted HR for subclinical carotid atherosclerosis development comparing patients with persistent NAFLD with patients with no evidence of NAFLD was 1.23 (95% CI, 1.13-1.35). This association remained even after adjusting for smoking, alcohol, BMI and weight change (HR = 1.13; 95% CI, 1.03–1.25). However, this did not remain the same for metabolic variables.

When comparing patients with regression of NAFLD with patients with persistent NAFLD, the HR was 0.82 (95% CI, 0.69–0.96). The risk for developing subclinical carotid atherosclerosis was higher in men with high NAFLD fibrosis score, high Fibrosis-4 scores and high levels of gamma-glutamyl transferase at baseline.

“This association was explained by metabolic factors that could be potential mediators of the effect of NAFLD,” the researchers concluded. “Prospective studies are needed to determine whether treatment of NAFLD can reduce this risk.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.