To study the carotid intima media thickness in patients of fatty liver disease
Keywords:AFLD, IMT, NIDDM, NAFLD
Background: Fatty liver is associated with several atherosclerotic risk factors such as hypertension, diabetes and dyslipidemia. It has also been related to insulin resistance. This association was found in NIDDM patients as well as in non-diabetic subjects. An increased intima-media thickness (IMT) has been shown to be a risk factor for myocardial infarction and stroke. The aim of the present study is to investigate associations between hepatic steatosis and the risk of atherosclerosis.
Methods: The present study was carried out on 88 patients of fatty liver disease and 80 controls in the department of General Medicine. An approximate equal number of age and sex matched persons without fatty liver were selected randomly as controls. Both fatty liver disease patients (i.e NAFLD and AFLD) and control group were further divided into two categories, one with risk factor for atherosclerosis and other without risk factors. Risk factors for atherosclerosis were taken according to ATP III guidelines.
Results: When comparison of mean CIMT was done in NAFLD, AFLD and controls in a particular age group, significant difference was found in mean CIMT (both sides) in age group 40-49 yrs (p value 0.03, 0.002 for right and left respectively). The difference was also significant in mean CIMT of right in age group 18-24 yrs (p value 0.015) and in >60 years (p value 0.03). Among, NAFLD patients, for left mean CIMT p value was 0.0001, for right mean CIMT p value was 0.0001. Among AFLD patients, for left mean CIMT p value was 0.006 and for right mean CIMT p value was 0.0022. Only statistically significant difference was found in mean CIMT (left) in grade II fatty liver (p value 0.04). NAFLD and controls without risk factors for atherosclerosis, mean CIMT (both side) in NAFLD was found to be significantly more than control (p value 0.04). AFLD patients and controls without risk factors for atherosclerosis, mean CIMT of both side in AFLD patients was found to be significantly more than controls (p value for left CIMT 0.02 and for right CIMT 0.00001).
Conclusions: CIMT was found to increase with advancing age in all three group i.e. NAFLD, AFLD and control group. CIMT was more in patients of fatty liver disease (both NAFLD and AFLD) having risk factor for atherosclerosis as compared to those without risk factors. Both NAFLD and AFLD are associated with increased CIMT in comparison to control group. As such all NAFLD and AFLD patients should be investigated for carotid atherosclerosis, as its early detection and management may be helpful in limiting the inherent complications of atherosclerosis.
Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatol. 2003;37(5):1202-19.
Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol. 2003;98(5):960-7.
Teli MR, James OF, Burt AD, Bennett MK, Day CP. The natural history of nonalcoholic fatty liver: A follow-up study. Hepatol. 1995;22:1714-9.
Akahoshi M, Amasaki Y, Soda M, Tominaga T, Ichimaru S, Nakashima E, et al. Correlation between fatty liver and coronary risk factors: A population study of elderly men and women in Nagasaki, Japan. Hypertens Res. 2001;24:337-43.
Banerji MA, Buckley MC, Chaiken RI, Gordon D, Lebovitz HE, Kral JG. Liver fat, serum triglycerides and visceral adipose tissue in insulin-sensitive and insulin-resistant black man in NIDDM. Int J Obes. 1995;19:846-50.
Goto T, Onuma T, Takebe K, Kral JG. The influence of fatty liver on insulin resistance in non-diabetic Japanese subjects. Int J Obes. 1995;19:841-5.
O‘Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14-22.
Long A, Lepoutre A, Corbillon E, Branchereau A. Critical review of non- or minimally invasive methods (duplex ultrasonography, MR- and CT-angiography) for evaluating stenosis of the proximal internal carotid artery. Eur J Vasc Endovasc Surg. 2002;24:43-52.
Kotronen A, Yki-Järvinen H, Männistö S, Saarikoski L, Korpi-Hyövälti E, Oksa H, et al. Non-alcoholic and alcoholic fatty liver disease - two diseases of affluence associated with the metabolic syndrome and type 2 diabetes: the FIN-D2D survey. BMC Public Health. 2010;10:237.
Agarwal R. Association of non-alcoholic fatty liver disease with obesity. Indian J Prev Ivc Med. 2008;39(1):2.
Diehl AM, Li ZP, Li HZ. Cytokines and pathogenesis of non-alcoholic steato hepatitis. Gut. 2005;54:303-6.
Corretti MC, Anderson TJ, Benjamin; International Brachial Artery Reactivity Task Force: Guidelines for the ultrasound assessment of the endothelial dependent flow mediated vasodilatation of the brachial artery. J Am Coll Cardiol. 2002;39:257-65.
AGA Technical Review on Non-alcoholic Fatty Liver Disease: Gastroenterol. 2002;123:1705-25.
Fauci L, Losacalzo KHJ. Harrison's Principles of Internal Medicine. Ed. 18, The McGraw-Hill Companies; 2012:2589-90.
Itoh S, Yougel T, Kawagoe K. Comparison between non-alcoholic steatohepatitis and alcoholic hepatitis. Am J Gastroenterol. 1987;82:650-4.
Jadhav VM, Kadam NN, Carotid intima media thickness as an independent predictor of coronary artery disease. Indian Heart J. 2001;53:458-62.
Tilg H, Moschen AR. Insulin resistance, inflammation, and non-alcoholic fatty liver disease. Trends Endocrinol Me- tab. 2008;19:371-9.
Kim JH, Kim SY, Jung ES, Jung SW, Koo JS, Kim JH, et al. Carotid intima-media thickness is increased not only in non-alcoholic fatty liver disease patients but also in alcoholic fatty liver patients. Digestion. 2011;84(2):149-55.
Kim HC. Association between NAFLD and CIMT according to the presence of metabolic syndrome. Atherosclerosis. 2009;204:521-5.
Lin YC, Lo HM, Chen JD. Sonographic fatty liver, overweight and ischemic heart disease. World J Gastroenterol. 2005;11:4838-42.
Brea A, Mosquera D, Martín E, Arizti A, Cordero JL, Ros E. Nonalcoholic fatty liver disease is associated with carotid atherosclerosis: a case-control study. Arterioscler Thromb Vasc Biol. 2005;25:1045-50.
Assy N, Djibre A, Farah R, Grosovski M, Marmor A. Presence of coronary plaques in patients with nonalcoholic fatty liver disease. 2010;254(2):393-400.
Sookoian S, Pirola CJ. Non-alcoholic fatty liver disease is strongly associated with carotid atherosclerosis: a systematic review. J Hepatol. 2008;49:600-7.