Abstract MP044: Fatty Liver Disease, Visceral Fat and Pectoral Muscle Area Are Independently Associated with Subclinical Atherosclerosis in Heavy Smokers

Abstract

Introduction: Cardiovascular disease is a leading cause of death in those with chronic obstructive pulmonary disease. Coronary artery calcium (CAC) is a subclinical measure of cardiovascular disease. Fatty liver disease and visceral fat (VAT) are associated with CAC, and pectoral muscle area (PMA) has been shown to be associated with CAC in our population. However, it is unclear if fatty liver disease, VAT and PMA are all independently associated with CAC or if confounding exists. Hypothesis: We hypothesized that fatty liver disease will be associated with CAC independent of VAT and PMA. Methods: We utilized cross-sectional data from COPDGene, a cohort of former and current smokers with at least 10 pack-years of smoking history with CT measures of CAC, VAT, PMA, and liver and spleen attenuation. CAC positivity was defined as greater than 2.5 units of square root transformed total CAC volume to account for measurement variability. The liver/spleen ratio (LSR) was calculated, and fatty liver disease was defined as LSR < 1. Multiple logistic regression was used to assess the association between the presence of CAC and fatty liver disease. Models were adjusted for age, sex, race, and current smoking, pack-years of smoking, high cholesterol, hypertension, diabetes, pectoral muscle area and visceral fat. Interactions between fatty liver disease and sex and fatty liver disease and race were tested. Results: Of the 5873 individuals with complete data, 3210 (54.7%) had CAC and 1153 (19.6%) had fatty liver disease. Both PMA (p<0.0001) and VAT (p=0.0002) were associated with having CAC, and with having fatty liver disease (p<0.0001 for both). There was a significant interaction between race and fatty liver disease (p=0.03). In non-Hispanic whites (NHW), fatty liver disease was associated with having CAC (OR=1.10, 95% CI 0.92-1.32), while in AA, fatty liver disease was not associated with CAC (OR=0.79, 95% CI 0.58-1.07). Removing VAT and PMA did not attenuate these results. There was no significant interaction between fatty liver disease and sex. Conclusion: In a large cohort of heavy smokers, fatty liver disease, VAT and PMA were associated with subclinical atherosclerosis independent of traditional cardiovascular risk factors in NHW but not AA. The racial differences in this association could indicate different biologic pathways in cardiovascular disease.