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Nonalcoholic Fatty Liver Disease for Identification of Preclinical Carotid Atherosclerosis

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ABSTRACT

Nonalcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease, yet whether identification of NAFLD in asymptomatic individuals is helpful over established risk factors remains unknown. A total of 37,799 asymptomatic adults aged 20 years or older who underwent comprehensive health check-up examination, including abdominal and carotid artery duplex ultrasonography (US) were included in the analysis. Nonalcoholic fatty liver disease was diagnosed with US and exclusion of secondary causes of fat accumulation or other causes of chronic liver disease, and graded as mild or moderate to severe fatty liver. Individuals with carotid plaque identified on carotid artery US were considered at risk for cardiovascular disease. Metabolic syndrome (MetS) was defined by the adult treatment panel III criteria. Nonalcoholic fatty liver disease was an independent factor associated with carotid plaque in a dose-dependent manner (odds ratio [OR]; 95% confidence interval [CI]: 1.09 [1.03–1.16] and 1.13 [1.06–1.21] for mild and ≥ moderate degree of NAFLD). Among clinically-relevant subgroups, NAFLD was more closely associated with carotid plaque in young adults (aged < 60 years) without MetS (OR [95% CI]: 1.13 [1.03–1.19] and 1.16 [1.06–1.27] for mild and ≥ moderate degree of NAFLD) than old adults (aged ≥ 60 years) or with MetS (OR [95% CI]: 1.06 [0.97–1.17] and 1.07 [0.97–1.19] for mild and ≥ moderate degree NAFLD). In young adults without MetS, the prevalence of carotid plaques was 32.8% and the sensitivity and specificity of NAFLD for carotid plaque was 0.38 and 0.67, respectively. In conclusion, NAFLD is associated with carotid plaque independent of traditional risk factors, especially in young adults without MetS. Nonalcoholic fatty liver disease could help identify additional individuals with preclinical atherosclerosis in asymptomatic young adults without MetS, yet, showed suboptimal performance as a screening tool.

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A, The prevalence of carotid plaques by age group. B, Number of metabolic syndrome components. C, Presence of nonalcoholic fatty liver disease. D, Nonalcoholic fatty liver disease fibrosis score. Carotid plaque was more frequently observed in adults with old age, those with metabolic syndrome, nonalcoholic fatty liver disease, and high nonalcoholic fatty liver disease fibrosis score.
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Figure 2: A, The prevalence of carotid plaques by age group. B, Number of metabolic syndrome components. C, Presence of nonalcoholic fatty liver disease. D, Nonalcoholic fatty liver disease fibrosis score. Carotid plaque was more frequently observed in adults with old age, those with metabolic syndrome, nonalcoholic fatty liver disease, and high nonalcoholic fatty liver disease fibrosis score.

Mentions: The prevalence of carotid plaques was 40.6% (15,363/37,799). Age, male sex, BMI, smoking status, number of MetS components, and NAFLD were independent factors associated with carotid plaque (Table 2). There was also a dose-dependent relationship between NAFLD degree and carotid plaque [odds ratio (OR) (95% confidence interval (CI)): 1.09 (1.03–1.16) and 1.13 (1.06–1.21) for mild and ≥ moderate degree of NAFLD]. The prevalence of carotid plaque increased with increasing age (1.8%, 13.6%, 29.7%, 45.9%, 60.7%, 74.3%, and 81.8% for age 20–29, 30–39, 40–49, 50–59, 60–69, 70–79, and ≥80 years, respectively, P < 0.001, Figure 2A), and with increasing number of MetS components (30.7%, 39.1%, 44.3%, 48.8%, 53.0%, and 55.4% for 0, 1, 2, 3, 4 and 5 MetS components, respectively, P < 0.001, Figure 2B). The prevalence of carotid plaque was higher in those with NAFLD (43.8% vs. 38.4%, P < 0.001, Figure 2C). In patients with NAFLD, NAFLD FS was associated with carotid plaque (OR [95% confidence interval]: 1.46 [1.42–1.50], P < 0.001), with a prevalence of 38.9%, 55.1%, and 71.3% for NAFLD FS < −1.455, −1.455 to 0.676, and ≥0.676, respectively (Figure 2D, P < 0.001). The optimal cutoff value of NAFLD FS for carotid plaque was −2.075. The prevalence of carotid plaque was higher in those with high NAFLD FS (≥−2.075) than in those with low NAFLD FS (<−2.075) (50.8% vs. 36.7%, P < 0.001).


Nonalcoholic Fatty Liver Disease for Identification of Preclinical Carotid Atherosclerosis
A, The prevalence of carotid plaques by age group. B, Number of metabolic syndrome components. C, Presence of nonalcoholic fatty liver disease. D, Nonalcoholic fatty liver disease fibrosis score. Carotid plaque was more frequently observed in adults with old age, those with metabolic syndrome, nonalcoholic fatty liver disease, and high nonalcoholic fatty liver disease fibrosis score.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC4998289&req=5

Figure 2: A, The prevalence of carotid plaques by age group. B, Number of metabolic syndrome components. C, Presence of nonalcoholic fatty liver disease. D, Nonalcoholic fatty liver disease fibrosis score. Carotid plaque was more frequently observed in adults with old age, those with metabolic syndrome, nonalcoholic fatty liver disease, and high nonalcoholic fatty liver disease fibrosis score.
Mentions: The prevalence of carotid plaques was 40.6% (15,363/37,799). Age, male sex, BMI, smoking status, number of MetS components, and NAFLD were independent factors associated with carotid plaque (Table 2). There was also a dose-dependent relationship between NAFLD degree and carotid plaque [odds ratio (OR) (95% confidence interval (CI)): 1.09 (1.03–1.16) and 1.13 (1.06–1.21) for mild and ≥ moderate degree of NAFLD]. The prevalence of carotid plaque increased with increasing age (1.8%, 13.6%, 29.7%, 45.9%, 60.7%, 74.3%, and 81.8% for age 20–29, 30–39, 40–49, 50–59, 60–69, 70–79, and ≥80 years, respectively, P < 0.001, Figure 2A), and with increasing number of MetS components (30.7%, 39.1%, 44.3%, 48.8%, 53.0%, and 55.4% for 0, 1, 2, 3, 4 and 5 MetS components, respectively, P < 0.001, Figure 2B). The prevalence of carotid plaque was higher in those with NAFLD (43.8% vs. 38.4%, P < 0.001, Figure 2C). In patients with NAFLD, NAFLD FS was associated with carotid plaque (OR [95% confidence interval]: 1.46 [1.42–1.50], P < 0.001), with a prevalence of 38.9%, 55.1%, and 71.3% for NAFLD FS < −1.455, −1.455 to 0.676, and ≥0.676, respectively (Figure 2D, P < 0.001). The optimal cutoff value of NAFLD FS for carotid plaque was −2.075. The prevalence of carotid plaque was higher in those with high NAFLD FS (≥−2.075) than in those with low NAFLD FS (<−2.075) (50.8% vs. 36.7%, P < 0.001).

View Article: PubMed Central - PubMed

ABSTRACT

Nonalcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease, yet whether identification of NAFLD in asymptomatic individuals is helpful over established risk factors remains unknown. A total of 37,799 asymptomatic adults aged 20 years or older who underwent comprehensive health check-up examination, including abdominal and carotid artery duplex ultrasonography (US) were included in the analysis. Nonalcoholic fatty liver disease was diagnosed with US and exclusion of secondary causes of fat accumulation or other causes of chronic liver disease, and graded as mild or moderate to severe fatty liver. Individuals with carotid plaque identified on carotid artery US were considered at risk for cardiovascular disease. Metabolic syndrome (MetS) was defined by the adult treatment panel III criteria. Nonalcoholic fatty liver disease was an independent factor associated with carotid plaque in a dose-dependent manner (odds ratio [OR]; 95% confidence interval [CI]: 1.09 [1.03&ndash;1.16] and 1.13 [1.06&ndash;1.21] for mild and &ge; moderate degree of NAFLD). Among clinically-relevant subgroups, NAFLD was more closely associated with carotid plaque in young adults (aged &lt; 60 years) without MetS (OR [95% CI]: 1.13 [1.03&ndash;1.19] and 1.16 [1.06&ndash;1.27] for mild and &ge; moderate degree of NAFLD) than old adults (aged &ge; 60 years) or with MetS (OR [95% CI]: 1.06 [0.97&ndash;1.17] and 1.07 [0.97&ndash;1.19] for mild and &ge; moderate degree NAFLD). In young adults without MetS, the prevalence of carotid plaques was 32.8% and the sensitivity and specificity of NAFLD for carotid plaque was 0.38 and 0.67, respectively. In conclusion, NAFLD is associated with carotid plaque independent of traditional risk factors, especially in young adults without MetS. Nonalcoholic fatty liver disease could help identify additional individuals with preclinical atherosclerosis in asymptomatic young adults without MetS, yet, showed suboptimal performance as a screening tool.

No MeSH data available.


Related in: MedlinePlus