A study presented today at the International Liver CongressTM 2013 - which evaluated the relationship between non-alcoholic fatty liver disease (NAFLD), early predictors of atherosclerosis and the 10-year Framingham risk score (FRS) - showed that NAFLD increases the risk of early atherosclerotic lesions independent of established cardiovascular (CV) risk factors.
NAFLD is one of the most common causes of chronic liver disease. Patients with NAFLD have an excess prevalence of CV events and typically have an increase frequency of risk factors already known to be directly related to atherosclerosis. As a consequence, it remains unclear if the presence of fatty liver should be regarded as an independent risk factor for CV disease.
Over 5000 patients with two or more traditional CV risk factors (without previous CV events), low alcohol intake (<50g/day) and without known liver diseases (viral hepatitis, hemochromatosis, Wilson disease or drug induced liver injury) underwent carotid ultrasonography with measurement of carotid intima-media thickness (C-IMT). Carotid plaques (CP) were defined as C-IMT>1,5 mm at carotid bifurcation. The Fatty Liver Index (FLI), a surrogate marker of hepatic steatosis when >60, and the Framingham score (FRS) were calculated.
Patients with a FLI of 60 or more also had a higher BMI and increased levels of liver enzymes (ALT, AST, GGT) (p<0.0001). They also had higher C-IMT and higher FRS (0.64+0.16 vs. 0.61+0.13, p< 0,0001 and 14.7+8.8 vs. 8.3+6.6, p< 0.0001 respectively). In multivariate analysis FLI was independently associated with C-IMT (p< 0.0001) and CP (beta =0.179,>
This study demonstrated that NAFLD is highly prevalent in patients at high risk of CV diseases and is an independent predictor of early atherosclerosis and 10-years CV risk beyond classical CV risk factors. These findings strengthen the evidence that NAFLD is a heterogeneous entity requiring a multidisciplinary approach and modified screening strategies.
Type-2 diabetes and dyslipidemia are known risk factors usually associated with cardiovascular and liver-related deaths in NAFLD. A second study presented today evaluated the 10-year prognostic value of non-invasive markers FibroTest and SteatoTest for overall survival (OS), survival without liver-related death (LRD) and cardiovascular-related death (CVD) in patients with diabetes and/or dyslipidemia without known liver disease.