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Noncalcified plaque levels higher in patients with fatty liver

Patients with nonalcoholic fatty liver disease who were asymptomatic for cardiovascular disease had significantly higher atherosclerotic plaque and noncalcified plaque compared with patients without NAFLD after coronary computed tomographic angiography, according to recently published data.

“These findings highlight the importance of preventive efforts to avoid cardiovascular events in asymptomatic individuals with NAFLD, for whom care should focus on early identification, personalized lifestyle modification, and appropriate medical treatments for NAFLD,” the researchers wrote.

Between February 2007 and December 2011, the researchers enrolled 5,121 individuals to participate in the study. According to results of ultrasonography, 1,979 participants had NAFLD. All patients underwent coronary computed tomographic angiography.

Compared with participants without NAFLD, those with NAFLD had significantly higher BMI (25.9 vs. 23.5 kg/m²; P < .001) and waist circumference (89.5 vs. 82.4 cm; P < .001); were more likely to have hypertension (43.6% vs. 29.2%; P < .001), diabetes (22.3% vs. 10.5%; P < .001) and hyperlipidemia (38.2% vs. 25.6%; P < .001); and had higher levels of aspartate aminotransferase (29.4 vs. 26.5 IU/L; P < .001), alanine aminotransferase (32.8 vs. 22.6 IU/L; P < .001), gamma-glutamyl transpeptidase (33.9 vs. 24.7 IU/L; P < .001) and fatty liver index (44 vs. 21.8; P < .001).

Patients with NAFLD also had higher coronary artery calcium scores (46 vs. 33.2; P < .001) and were more likely to have any atherosclerotic plaque (47.9% vs. 36.2%; P < .001), calcified plaque (31.2% vs. 24%; P < .001), noncalcified plaque (22.2% vs. 15.9%; P < .001), mixed plaque (10.9% vs. 7.5%; P < .001), and coronary artery stenosis (10.3% vs. 6.4%; P < .001).

After the researchers adjusted for age, sex, obesity, diabetes, hypertension, hyperlipidemia, smoking status, family history of cardiovascular disease and high-sensitivity C-reactive protein, NAFLD did not significantly correlate with coronary artery calcification, calcified plaque or mixed plaque.

However, they did find a significant association between NAFLD and any atherosclerotic plaque (OR = 1.18; 95% CI, 1.03-1.35), noncalcified plaque (OR = 1.27; 95% CI, 1.08-1.48) and significant coronary artery stenosis (OR = 1.28; 95% CI, 1.02-1.61).

Additionally, after multivariate adjustment, the researchers observed a significant association between patients with fatty liver index of 30 or higher and noncalcified plaque (OR = 1.37; 95% CI, 1.14-1.65) and between NAFLD fibrosis score of –1.455 or higher and noncalcified plaque (OR = 1.2; 95% CI, 1.08-1.42).

“Individuals with NAFLD had a higher prevalence of traditional risk factors associated with cardiovascular morbidity and mortality,” the researchers concluded. “After adjustment for clinical and laboratory variables, the incidence of calcified or mixed plaques did not differ between individuals with and without NAFLD. On the contrary, only noncalcified plaque was independently associated with NAFLD.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.