Abstract
Objective: To evaluate the relationship between retinal vascular caliber and cardiovascular disease in non-alcoholic fatty liver disease (NAFLD) patients without diabetes and hypertension. Methods: Intention to treat study of individuals who underwent cardiac computed tomography (CT) during a two year period. Coronary artery disease (CAD) was defined as stenosis of >50% in at least one major coronary artery. Liver and spleen density were measured by abdominal (CT); intima-media thickness (IMT) by Doppler ultrasound; retinal artery and vein diameter by colored-retinal angiography; and metabolic syndrome by ATP III guidelines. Serum biomarkers of insulin resistance, inflammation, and oxidant-antioxidant status were assessed. Results: Compared with 22 gender and age matched controls, the 29 NAFLD patients showed higher prevalence of coronary plaques (70% vs. 30%, p < 0.001), higher prevalence of coronary stenosis (30% vs. 15%, p < 0.001), lower retinal arteriole-to-venule ratio (AVR) (0.66 ± 0.06 vs. 0.71 ± 0.02, p < 0.01), higher IMT (0.98 ± 0.3 vs. 0.83 ± 0.1, p < 0.04), higher carotid plaques (60% vs. 40%, p < 0.001), higher homeostasis model assessment of insulin resistance (HOMA) (4.0 ± 3.4 vs. 2.0 ± 1.0, p < 0.005), and higher triglyceride levels (200 ± 80 vs. 150 ± 60, p < 0.005) than controls. Multivariate analysis showed fatty liver (OR 2.5; p < 0.01), IMT (OR 2.3 p < 0.001), and retinal AVR ratio (OR 1.5, p < 0.01) to be strongly associated with CAD independent of metabolic syndrome (OR 1.2, p < 0.05). Conclusions: Patients with smaller retinal AVR (<0.7) are likely to be at increased risk for CAD and carotid atherosclerosis in patients with NAFLD even without hypertension or diabetes.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized as the most common liver disorder in Western countries
Patients with smaller retinal arteriole-to-venule ratio (AVR) (
Retinal arteriolar abnormalities have been recognized as associating with hypertension and diabetes mellitus
Summary
Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized as the most common liver disorder in Western countries. It is the most common cause of liver enzyme abnormalities in clinical practice, with a prevalence of 46% in the general population, increasing steadily to 70%–90% in obese and type 2 diabetic patients [1,2]. The pathogenesis of NAFLD includes four major mechanisms: lipotoxicity of fatty acids, insulin resistance, systemic inflammation, and increased oxidative stress and lipid peroxidation [3,4]. Elevated prothrombotic factors that aggravate atherosclerosis have been implicated in nonalcoholic steatohepatitis (NASH) [5,6], the evolutive counterpart of NAFLD. CT scanning has no role in clinical practice, and ultrasound (US) represents the first line imaging technique and may be useful when semi-quantitative indices are determined [7]
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