Daniel M. Keller, PhD

May 16, 2013

AMSTERDAM, the Netherlands — In subjects at high risk for cardiovascular events, there is an increased prevalence of nonalcoholic fatty liver disease, and that prevalence correlates with predictors of atherosclerosis, according to a large cohort study.

We found that fatty liver disease independently predicts early atherosclerosis and 10-year risk for cardiovascular disease, beyond the traditional risk factors, said Raluca Pais, MD, from the Université Pierre et Marie Curie in Paris, France.

Dr. Pais presented the study results here at the International Liver Congress 2013.

The study cohort consisted of subjects with at least 2 cardiovascular risk factors, including dyslipidemia, hypertension, diabetes, high fasting glucose, obesity, and smoking. Subjects had no previous cardiovascular events, no known causes of chronic liver disease other than fatty liver disease, and alcohol intake was 50 g/day or less.

Of the 5685 study subjects, 2073 (36.5%) had fatty liver disease.

About half the study subjects were men, mean age was 55 years, and mean body mass index was 26.4 kg/m². Mean carotid intima-media thickness on ultrasound was 0.62 mm, and 26% had at least 1 carotid plaque. Mean Framingham risk score was 10.6.

Mean fatty liver index score was 45. This score is calculated on the basis of body mass index, waist circumference, triglyceride level, and gamma-glutamyl transferase level, and a score of 60 or more is a marker of hepatic steatosis.

Subjects with a fatty liver index score above 60 had a higher body mass index than those with a lower score, and higher levels of alanine transaminase, aspartate transaminase, and gamma-glutamyl transferase (< .001 for all). They also had greater carotid intima-media thickness (0.64 vs 0.61 mm; < .001) and higher 10-year Framingham risk scores (14.7 vs 8.3; < .001).

The prevalence of carotid plaques was higher in subjects with fatty liver disease than in those without (29% vs 25%; P < .001).

The interaction between fatty liver index score and the presence of carotid plaques was age dependent.

For subjects 50 years and older, the prevalence of plaques was higher in those with a fatty liver index score above 60 than in those with a lower score (36% vs 32%; P = .01). For younger subjects, there was no significant difference (10% vs 12%). The index was independently associated with the Framingham risk score (< .001).

On multivariate analysis, fatty liver index score was independently correlated with carotid intima-media thickness (P < .001) and carotid plaques (P = .01), independent of age, cholesterol level, or the presence of diabetes or hypertension.

Better Than Traditional Risk Predictors?

This study suggests that fatty liver disease is a heterogeneous entity requiring a multidisciplinary approach and modified screening strategies, Dr. Pais concluded.

Is the fatty liver index any better than traditional risk predictors for coronary heart disease?

"These data will have to be duplicated before you can really answer that question with certainty. But this is exactly what these authors were trying to show — that you can use this test in your daily practice, Jean-François Dufour, MD, told Medscape Medical News. Dr. Dufour, who is professor of hepatology at the University of Bern in Switzerland, was not involved in the study.

"Although patients with nonalcoholic fatty liver disease have long been known to suffer from excess cardiovascular disease," Dr. Dufour noted, "it was unclear whether this was mediated through a higher risk for earlier atherosclerotic lesions. This study shows that nonalcoholic fatty liver disease is an independent predictor of cardiovascular risk."

The authors have disclosed no relevant financial relationships. Dr. Dufour is an investigator with the Fatty Liver: Inhibition of Progression Consortium.

International Liver Congress 2013: 48th Annual Meeting of the European Association for the Study of the Liver (EASL). Abstract 1356. Presented April 26, 2013.

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