Article

Association between nonalcoholic fatty liver disease and coronary artery disease

Department of Cardiology, Gazi University Medical School, Ankara, Turkey.
Coronary Artery Disease (Impact Factor: 1.3). 09/2007; 18(6):433-6. DOI: 10.1097/MCA.0b013e3282583c0d
Source: PubMed

ABSTRACT To demonstrate whether there is a relationship between the presence of nonalcoholic fatty liver disease (NAFLD) and the presence and extent of coronary artery disease (CAD).
Ninety-two consecutive patients who planned to undergo coronary angiographies (CAG) without known CAD, other than findings of acute coronary syndrome, were enrolled in this study. Abdominal ultrasonography was performed before the CAG to detect NAFLD. CAD was defined as a stenosis of at least 50% in at least one major coronary artery. The extent of CAD was measured according to the number of major coronary artery/arteries affected by CAD. All the risk factors for CAD were included in a binary logistic regression model. Forward, backward, or step-wise selections were not used. P<0.05 was accepted as being significant.
Sixty-five of the 92 patients (70.7%) were detected, by abdominal ultrasonography, to have fatty liver and 43 patients out of 92 (46.7%) were detected, by CAG, to have significant CAD. According to the results of logistic regression analysis, the presence of NAFLD independently increased the risk for CAD, as seen in CAG [odds ratio (OR), 95% confidence interval (CI): 6.73 (1.14-39.61); P=0.035]; this was despite factoring in the other risk factors for CAD and the components of metabolic syndrome. NAFLD was more commonly found in patients as the extent of CAD increased (P=0.001).
The presence of NAFLD is independently associated with the presence and extent of CAD. Future studies are needed to explain the mechanisms of this relationship.

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    • "Similarly, in a large outpatient-cohort study of patients with T2DM, the prevalence of coronary, cerebrovascular and peripheral vascular disease was greater among those with NAFLD than among those without this disease, independently of traditional CVD risk factors, medication use and diabetes-related variables [81]. Finally, in patients referred for clinical coronary angiography, NAFLD was independently associated with increased severity of coronary artery disease [82] [83] [84]. "
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    ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries that is predicted to become also the most frequent indication for liver transplantation by 2030. Over the last decade, it has been shown that the clinical burden of NAFLD is not only confined to liver-related morbidity and mortality, but there is now growing evidence that NAFLD is a multisystem disease, affecting extra-hepatic organs and regulatory pathways. For example, NAFLD increases risk of type 2 diabetes mellitus (T2DM), cardiovascular (CVD) and cardiac diseases, and chronic kidney disease (CKD). Although the primary liver pathology in NAFLD affects hepatic structure and function to cause morbidity and mortality from cirrhosis, liver failure and hepatocellular carcinoma, the majority of deaths among NAFLD patients are attributable to CVD. This narrative review focuses on the rapidly expanding body of clinical evidence that supports the concept of NAFLD as a multisystem disease. The review discusses the factors involved in the progression of liver disease in NAFLD and the factors linking NAFLD with other extra-hepatic chronic diseases, such as T2DM, CVD, cardiac diseases and CKD. The review will not discuss NAFLD treatments as these are discussed elsewhere in this issue of the Journal. For this review, PubMed was searched for articles using the keywords "non-alcoholic fatty liver disease" or "fatty liver" combined with "diabetes", "cardiovascular (or cardiac) disease", "cardiovascular mortality" or "chronic kidney disease" between 1990 and 2014. Articles published in languages other than English were excluded. Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
    Journal of Hepatology 04/2015; 62(1S):S47-S64. DOI:10.1016/j.jhep.2014.12.012 · 10.40 Impact Factor
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    • "In a recent study, Iacobellis et al. demonstrated that EAT thickness was found to be a good predictor of steatosis of non-cardiac organs such as the liver [33]. We previously showed that a relationship exists between nonalcoholic fatty liver disease and the presence of coronary artery disease [34]. These findings may also support the role of EAT on the process of coronary artery disease. "
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    ABSTRACT: Background Increased epicardial adipose tissue thickness and plasma homocysteine levels are associated with Metabolic Syndrome (MS) and coronary artery disease. The majority of patients with MS have subclinical or manifest coronary artery disease. The aim of this study was to evaluate the relationship between MS and plasma homocysteine levels and epicardial adipose tissue thickness in subjects without epicardial coronary artery disease. Methods Patients who underwent coronary angiography due to angina or equivocal symptoms and/or abnormal stress test results and were found to have normal coronary arteries were evaluated for the presence of MS. The study group comprised 75 patients with normal coronary arteries and MS, and the control group included 75 age-gender matched subjects without coronary artery disease or MS. Results Epicardial adipose tissue thickness (5.8 ± 1.9 mm vs. 4.3 ± 1.6 mm, p <0.001) and plasma homocysteine levels (21.6 ± 6.1 μmol/L vs. 15.1 ± 5.8 μmol/L, p <0.001) were significantly higher in the MS group. Body mass index, triglyceride level, weight, age and waist circumference were positively and HDL cholesterol level were negatively correlated with both epicardial adipose tissue thickness and plasma homocysteine level. Epicardial adipose tissue thickness had the strongest correlation with plasma homocysteine level (r = 0.584, p < 0.001). For each 1 mm increase in epicardial adipose tissue thickness, an increase of 3.51 μmol/L (95% CI: 2.24-4.79) in plasma homocysteine level was expected. Conclusions We observed a close relationship between MS and epicardial adipose tissue thickness and plasma homocysteine levels, even in the absence of overt coronary artery disease.
    Diabetology and Metabolic Syndrome 05/2014; 6(1):62. DOI:10.1186/1758-5996-6-62 · 2.50 Impact Factor
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    • "Non-alcoholic fatty liver disease (NAFLD) which is considered as a hepatic manifestation of MS [10] has an increasing prevalence in Western countries. NAFLD has been found to be associated with increased risk for coronary artery disease (CAD) independent of MS and its components [11], but until now, no study has been conducted to investigate the relationship between NAFLD and coronary collateral circulation (CCC) which is related to poor cardiovascular outcomes in patients with severe CAD. CCC may be also impaired in patients with NAFLD which shares IR as the common pathophysiological mechanism with type 2 DM, whose presence is known to be associated with poor collateral development [3,6–8]. "
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