Abstract
BackgroundThere is increasing concern regarding cardiovascular risk in individuals with non-alcoholic fatty liver disease. This study was conducted to evaluate whether hepatic steatosis with or without fibrosis is associated with the progression of carotid atherosclerosis in patients with type 2 diabetes.MethodsFrom a longitudinal cohort, we enrolled 1120 patients with type 2 diabetes who underwent repeated carotid artery ultrasonography every 1–2 years. Ultrasonographic findings at baseline and after 6–8 years were compared. Presence of hepatic steatosis was mainly assessed by abdominal ultrasonography; patients with hepatic steatosis were further evaluated for hepatic fibrosis according to fibrosis-4 index. We investigated the association between liver status and atherosclerosis progression.ResultsOf 1120 patients, 636 (56.8%) were classified as having hepatic steatosis at baseline. After 6–8 years, 431 (38.5%) showed atherosclerosis progression. Hepatic steatosis was significantly associated with atherosclerosis progression (adjusted odds ratio[AOR]: 1.370, 95% CI 1.025–1.832; p < 0.05). Among patients with hepatic steatosis, only individuals with fibrosis showed significant association with atherosclerosis progression (AOR: 1.615, 95% CI 1.005–2.598; p < 0.05). The association between hepatic fibrosis and atherosclerosis progression was significant in all metabolic subgroups regardless of age, body mass index, presence of metabolic syndrome, or insulin sensitivity (all p < 0.05). Furthermore, subjects with hepatic steatosis & fibrosis and ≥ 4 components of metabolic syndrome criteria showed markedly increased risk of atherosclerosis progression (AOR: 2.430, 95% CI 1.087–5.458; p < 0.05).ConclusionsHepatic steatosis with fibrosis is independently associated with the progression of carotid atherosclerosis in patients with type 2 diabetes.
Highlights
There is increasing concern regarding cardiovascular risk in individuals with non-alcoholic fatty liver disease
After several efforts to prove this relationship via carotid ultrasonography, it was discovered that non-alcoholic fatty liver disease (NAFLD) was significantly associated with carotid stenosis in Chinese population [49], increased carotid intima-media thickness (IMT) in type 2 diabetes patients with insulin resistance [3], and higher prevalence of carotid plaque [14]
We focused on the long-term effect of NAFLD with or without significant fibrosis on atherosclerosis by repeated carotid ultrasonography
Summary
There is increasing concern regarding cardiovascular risk in individuals with non-alcoholic fatty liver disease. Non-alcoholic steatohepatitis (NASH), one of several categories of NAFLD which is characterized by lobular inflammation and hepatocyte ballooning, produces more significant liver injury like fibrosis or cirrhosis compared to simple NAFLD [8], and patients with NASH were reported to have much higher incidence of coronary artery disease-related mortality [9,10,11]. It might be important to assess hepatic steatosis and fibrosis to identify those at high risk of cardiovascular disease, and to optimally commence medical interventions [16, 17] This scenario is of special concern in patients with type 2 diabetes, which is known to be associated with higher risk of NAFLD [16, 18]. Little is known about the longitudinal effects of NAFLD or NASH on systemic atherosclerosis in type 2 diabetes
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