Severity of coronary artery disease is associated with non-alcoholic fatty liver dis-ease: A single-blinded prospective mono-center study.

Mireen Friedrich-Rust,Joerg Bojunga,Eva Herrmann,Florian Seeger,Julia Rey,Stefan Zeuzem,Stephan Fichtlscherer,Fabian Schoelzel,Sebastian Maier,Pavel Strnad

doi:10.1371/journal.pone.0186720

Abstract

Background and aimsLiver steatosis has shown to be associated with coronary artery disease (CAD). The aim of our study was to evaluate the association between the presence and severity of CAD and Non-alcoholic fatty liver disease (NAFLD) assessed by transient elastography (TE) and controlled attenuation parameter (CAP).Methods576 Patients undergoing coronary angiography were enrolled in this prospective study, receiving at least 10 TE and CAP measurements using the FibroScan® M-probe. Clinically relevant CAD (CAD 3) was defined as stenosis with ≥75% reduction of the luminal diameter. NAFLD was determined by CAP ≥234 dB/m. NAFLD with advanced fibrosiswas determined by TE-values ≥7.9kPa in the presence of NAFLD and absence of congestive or right-sided heart failure. Rates and 95% confidence intervals are shown.Results505 patients were available for analysis of NAFLD. However, only 392 patients were available for analysis of NAFLD with advanced fibrosis, since 24 patients had to be excluded due to non valid TE-measurements and 89 patients due to congestive or right-sided heart failure or suspected concomitant liver disease, respectively. 70.5% (66.3%-74.4%) of patients had CAD 3, 71.5% (67.3%-75.4%) were diagnosed with NAFLD, and 11.2% (8.3%-14.8%) with NAFLD with advanced fibrosis. Patients with CAD 3 had higher median CAP-values (273±61 vs. 260±66 dB/m; p = 0.038) and higher degrees of steatosis as compared to patients without CAD 3. While NAFLD was significantly more often diagnosed in patients with CAD 3 (75.0% vs. 63.1%, p = 0.0068), no significant difference was found for NAFLD with advanced fibrosis (10.7% vs. 12.5%, p = 0.60).ConclusionsClinically relevant CAD is frequently associated with the presence of NAFLD, but not NAFLD with advanced fibrosis.

Highlights

Non-alcoholic fatty liver disease (NAFLD), considered to be the hepatic manifestation of metabolic syndrome (MS), is the most common liver disorder in industrialized countries and it is associated with a significantly increased risk for coronary artery disease (CAD) [1, 2]
Only 392 patients were available for analysis of NAFLD with advanced fibrosis, since 24 patients had to be excluded due to non valid transient elastography (TE)-measurements and 89 patients due to congestive or right-sided heart failure or suspected concomitant liver disease, respectively. 70.5% (66.3%-74.4%) of patients had CAD 3, 71.5% (67.3%-75.4%) were diagnosed with NAFLD, and 11.2% (8.3%14.8%) with NAFLD with advanced fibrosis
While NAFLD was significantly more often diagnosed in patients with CAD 3 (75.0% vs. 63.1%, p = 0.0068), no significant difference was found for NAFLD with advanced fibrosis (10.7% vs. 12.5%, p = 0.60)

Summary

Introduction

Non-alcoholic fatty liver disease (NAFLD), considered to be the hepatic manifestation of metabolic syndrome (MS), is the most common liver disorder in industrialized countries and it is associated with a significantly increased risk for coronary artery disease (CAD) [1, 2]. In conventional B-mode ultrasound (US), steatosis can only be detected if >30% of hepatocytes are affected by lipid accumulation with a sensitivity and specificity of >80% [5, 6]. The aim of our study was to evaluate the association between the presence and severity of CAD and Non-alcoholic fatty liver disease (NAFLD) assessed by transient elastography (TE) and controlled attenuation parameter (CAP)

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Conclusion