CORONARY ARTERY CALCIFICATION AS A MARKER OF SUBCLINICAL ATHEROSCLEROSIS IN PATIENTS OF NON ALCOHOLIC FATTY LIVER DISEASE

Abstract

Objective: Non Alcoholic Fatty Liver Disease (NAFLD) has been proposed to have a strong association with coronary artery disease(CAD) and subclinical atherosclerosis . Coronary artery calcification (CAC) is the well-established non-invasive surrogate index of atherosclerotic burden in arterial beds independent of conventional risk factors. Present study was an attempt to assess CAD risk in NAFLD patients by estimating coronary calcification. Design and method: cross sectional. Sonographically confirmed NAFLD patients between 30-60 years of either sex were included after obtaining informed consent and study approval by institutional ethics committee. Those with alcohol intake,acute and chronic infectious diseases, patients on parenteral nutrition, hepatotoxic drug intake, pregnant and lactating women and known CAD were excluded. History, Examination and investigations were recorded. CAC estimation was performed using 384 slice Dual source machine and CAC score was calculated by Agatston method. Statistical analysis by SPSS. Results: Out of 152 NAFLD patients, 79 (52.0%) were Grade I, 37 (24.3%) were Grade II and 36 (23.7%) Grade III. Mean age was 49 years with 86 males and 66 females. Considering comorbidities; 47 were diabetic,62 hypertensive, 36 hypothyroid and 6 dyslipidemic. CACS of patients ranged from zero to 620.80. Observed CACS and CAD Risk in NAFLD patients Significantly increased CACS were observed in Grade III NAFLD cases (208.08±193.92) followed by Grade II (53.90±82.67) and minimum in Grade I (9.84±52.93). Conclusions: Accelerated atherosclerosis in NAFLD maybe due to high oxidative stress,inflammatory markers like TNF Alpha, interleukin-6, oxidized LDL, insulin resistance, and macrophage activation. Present study was conducted to estimate coronary artery calcification in NAFLD by determining coronary artery calcium scores. Higher grades of NAFLD patients had moderate to high risk of CAD as evidenced by high CACS. This study shows that asymptomatic patients of NAFLD may have high atherosclerotic burden thus need to commence preventive measures before occurrence of an adverse CV event.