Radiology: Volume 254: Number 2—February 2010
Nimer Assy, MD Agness Djibre, MD Raymond Farah, MD Maria Grosovski, PhD Alon Marmor, MD
Purpose: To evaluate the relationship between nonalcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) and to define determinants of CAD in patients with or without metabolic syndrome.
Materials and Methods: This study was approved by the local ethics committee; informed consent was obtained. Twenty-nine subjects (mean age, 53 years ± 7 [standard deviation]) with low to intermediate risk for CAD and with fatty liver were included. Thirty-two sex- and age-matched individuals without NAFLD served as controls. CAD was defined as a stenosis of more than 50% in at least one major coronary artery. Fatty liver was assessed by means of an attenua¬tion of -10 HU or higher (calculated as liver attenuation minus spleen attenuation) by using computed tomography (CT), coronary plaques and stenosis by using CT coronary angiography, and biomarkers of insulin resistance, lipo-toxicity, systemic inflammation, and oxidant and antioxi¬dant status. A logistic regression analysis was performed to study multivariable associations.
Results: When compared with controls, NAFLD patients showed a higher prevalence of calcified and noncalcified coronary plaques (67% vs 34% and 52% vs 29%, respectively; both P < .001), higher prevalence of nonobstructive coronary stenosis (34% vs 14%; P < .008), higher homeostasis model assessment of insulin resistance (3.8 µU/mL ± 3.6 vs 2.6 µU/mL ± 3.2; P < .005) and higher triglyceride levels (208 mg/dL ± 87 vs 148 mg/dL ± 70; P < .005). Fatty liver proved to be a strong predictor of coronary athero¬sclerosis (odds ratio [OR], 2; P < .04), independent of indicators for metabolic syndrome (OR, 1.2; P > .2) and C-reactive protein levels (OR, 0.7; P > .4).
Conclusion: Patients with NAFLD, even without metabolic syndrome, are at high risk for atherosclerosis. Assessment of NAFLD may be helpful for cardiovascular risk stratification