Patients with nonalcoholic fatty liver disease may be at greater risk for developing coronary artery calcification regardless of the presence of other typical risk factors, according to recent results.
In a cross-sectional study, researchers evaluated 4,023 patients without a history of ischemic heart disease or known liver disease, using the Agatston method to calculate coronary artery calcification (CAC). Each patient also answered a questionnaire and underwent anthropometric assessment in additional to laboratory evaluations, and abdominal fat was measured via CT in 1,854 participants,
Nonalcoholic fatty liver disease (NAFLD) was diagnosed via ultrasonography in 1,617 participants (40.2%). Most patients did not have detectable CAC (n=2,737), and the majority of those with calcification had CAC scores between 10 and 100. The proportion of patients with NAFLD increased progressively with CAC score.
Multivariate analysis indicated an association with NAFLD after adjusting for traditional coronary risk factors (OR=1.28; 95% CI, 1.04-1.59). This association was stronger among patients who lacked risk factors such as advanced age (OR=3.14 among patients aged 54 years or younger; 95% CI vs. OR=1.50 among patients aged 55 years or older; 95% CI), hypertension (OR=1.97 among nonhypertensive patients; 95% CI vs. OR=1.37 among those with hypertension; 95% CI) or diabetes (OR=1.84 for patients without diabetes; 95% CI vs. OR=1.46 in patients with diabetes; 95% CI).
Among the patients whose abdominal fat was measured, 770 had NAFLD. Multivariate analysis of data from these patients maintained the association between NAFLD and increased CAC scores (OR=1.60; 95% CI, 1.32-1.93). In a model also including cholesterol and triglyceride levels, the association remained significant for the presence of CAC (OR=1.29; 95% CI, 1.03-1.62) and for increased scores (OR=1.28; 95% CI, 1.04-1.59), but not for CAC scores of 100 or greater (OR=1.30; 95% CI, 0.94-1.80).
“Patients with NAFLD are at high risk for coronary atherosclerosis regardless of classical cardiovascular risk factors, especially visceral adiposity,” the researchers wrote. “Detection of NAFLD should signal the existence of an increased coronary artery disease risk independent of visceral adiposity.”