Abstract
Visceral obesity is characterized by a low-grade inflammatory systemic state that contributes to the genesis of non-alcoholic fatty liver disease (NAFLD), frequently associated with liver fibrosis. Non-invasive serum markers have recently emerged as reliable, easy-to-use scores to predict liver fibrosis. NAFLD is often linked to metabolic and cardiovascular risk. Thus, in this cross-sectional study, we investigated in a population of 1225 subjects if AST to Platelet Ratio Index (APRI), one of the non-invasive liver fibrosis serum markers, can predict cardiovascular risk (CVR). APRI has been previously validated as an efficient score to predict liver fibrosis in viral hepatitis patients with a cut-off of 0.5 for fibrosis and 1.5 for cirrhosis. Our study showed that APRI significantly correlates with CVR and determines, when elevated, a significant increase in CVR for both genders, especially females. This spike in CVR, observed when APRI is elevated, is relatively high in patients in the age of 51–65 years, but it is significantly higher in younger and premenopausal women, approaching risk values usually typical of men at the same age. Taken together, our data highlighted the role of APRI as a reliable predictor easy-to-use score for CVR in metabolic patients.
Highlights
Abbreviations alkaline phosphatase (ALP) Alkaline phosphatase alanine transaminase (ALT) Alanine transaminase aspartate transaminase (AST) Aspartate transaminase BMI Body Mass Index carotid intima media thickness (cIMT) Carotid intima media thickness DBP Diastolic blood pressure ESR Erythrocyte sedimentation rate gamma-glutamyl transferase (GGT) Gamma-glutamyltransferase HbA1c Glycosylated hemoglobin HDL-C High-density lipoprotein cholesterol LDL-C Low-density lipoprotein cholesterol SBP Systolic blood pressure TC Total cholesterol TG Triglyceride Hs-CRP High-sensitivity C reactive protein waist circumferences (WC) Waist circumference
MetS is a clinical condition characterized by several risk factors for heart disease, diabetes, visceral obesity and low-grade chronic inflammatory status
MetS is part of a multisystem condition with multiple associations and each condition contributes to increment cardiovascular risk (CVR): diastolic d ysfunction[22,23], increased carotid intima media thickness[24], increased oxidative stress[25,26], altered lipid p rofile[27,28] and systemic inflammation are among the most important pathophysiological mechanisms responsible for increase CVR and cardiovascular disease (CVD) in MetS patients
Summary
Abbreviations ALP Alkaline phosphatase ALT Alanine transaminase AST Aspartate transaminase BMI Body Mass Index cIMT Carotid intima media thickness DBP Diastolic blood pressure ESR Erythrocyte sedimentation rate GGT Gamma-glutamyltransferase HbA1c Glycosylated hemoglobin HDL-C High-density lipoprotein cholesterol LDL-C Low-density lipoprotein cholesterol SBP Systolic blood pressure TC Total cholesterol TG Triglyceride Hs-CRP High-sensitivity C reactive protein WC Waist circumference. Since 2000, the MetS definition has seen several upgrades and changes, the last being in 2006, when the International Diabetes Federation (IDF) established the following criteria to define the MetS: i.e. waist circumference (WC) > 94 cm in males or > 80 cm in females; Systolic Arterial Pressure (SAP) ≥ 130 mmHg or diastolic blood pressure ≥ 85 mmHg The excess of visceral fat is considered crucial for MetS complications, as it is to determine a major increment in cardiovascular risk[4,5]. Sub-clinical inflammation, along with increased insulin resistance and an array of additional health problems, contributes to the genesis of major complications of MetS: atherosclerotic plaque formation, Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-alcoholic Steato-hepatitis (NASH)[6]. Liver biopsy is the gold standard for the NASH diagnosis, non-invasive markers of fibrosis are being incorporated into the routine clinical care of patients with liver disease. The availability of accurate non-invasive tests has allowed to screen large cohorts for significant liver diseases, allowing the assessment of the real burden of the liver disease in the general population
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