NON-ALCOHOLIC FATTY LIVER DISEASE AND CORONARY ARTERY CALCIFICATION SCORE BY MULTI-DETECTOR COMPUTED TOMOGRAPHY; CROSS-SECTIONAL CASE-CONTROL STUDY FROM HEALTHCARE CENTERS` NETWORK

Abstract

Background and Aims: Non-alcoholic Fatty Liver Disease (NAFLD) is known to be related to risk factors of coronary heart disease (CHD) such as dyslipidemia, diabetes, central obesity, and metabolic syndrome. The aim of this study has been to investigate whether NAFLD was associated with coronary artery calcification (CAC) score which used as surrogate marker for coronary atherosclerosis. Methods: 4,023 (mean age 56.85±9.38, male 60.7%) of 5,648 subjects in general health examination from Healthcare centers network were enrolled without known liver disease (alcoholic, HBV, HCV, other hepatitis history) and history or symptom of ischemic heart disease from 2004 to 2008. NAFLD was diagnosed by typical sonographic findings in the subjects with <20 gram/day alcohol consumption, based on questionnaire. CAC was evaluated by Agaston method with multi-detector computed tomography. CAC score was grouped into two categories over 2 sets of cut points: CAC prevalence (over 0), 0 to 100 and >100. Clinical characteristics included sex, age, BMI, waist circumference (WC), AST, ALT, total cholesterol, HDL cholesterol, triglycerides (TG), and glucose. Results: In our study population, CAC prevalence (over 0) was in 1,286 of 4,023 (32.0%) and moderate-severe CAC score (>100) was observed in 434 of 4,023 (10.8%). CAC was significantly associated with age, sex, BMI, WC, ALT, TG, HDL and with increased odds of diabetes, hypertension, metabolic syndrome, and severity of NAFLD. CAC prevalence showed positive relationship with NAFLD (OR 1.36, 95% CI 1.15–1.59, p < 0.0001) and moderate-severe CAC score showed also positive association with NAFLD (OR 1.28, 955 CI 1.012–1.61, p = 0.039). Multivariate regression analysis showed that CAC score was associated with male sex (OR 2.73), Age (<50 yr reference; 50–59 yr OR 3.75; 60–69 yr OR 8.42; over 70 yr OR 21.38), diabetes (OR 1.39), hypertension (OR 1.79), current smoker (OR 1.42) and presence of NAFLD (OR 1.36). Conclusions: Patients with NAFLD are at high risk of coronary atherosclerosis regardless of individuals traits of metabolic syndrome and classical cardiovascular risk factors. Detection of NAFLD should alert to the existence of an increased cardiovascular risk.