Non-alcoholic fatty liver disease and ultrasound markers of obesity as unfavorable factors in the course of coronary artery disease

Abstract

Aim. To evaluate the association of non-alcoholic fatty liver disease (NAFLD) with markers of visceral obesity in patients with coronary artery disease (CAD).Material and methods. We examined 125 patients hospitalized in the emergency cardiology department with CAD (female — 41,6%, male — 58,4%) and body mass index of 18,5-35,0 kg/m2. The median age of the subjects was 68 [61,0;74,0] years. We assessed following ultrasound parameters of visceral obesity: intraabdominal fat thickness (IAFT), abdominal wall fat index (WFI), preperitoneal fat thickness (PFT), subcutaneous adipose tissue (SAT), represented by MinSAT and MaxSAT. The following liver parameters were assessed: anteroposterior dimension of the left lobe and oblique-vertical dimension of the right lobe. Statistical data processing was carried out using the Statistica 6.0 program. Quantitative variables are presented as median (Me). Percentiles (25%; 75%) were used as dispersion measures. The influence of several predictors was assessed using linear regression analysis.Results. In patients without echographic signs of hepatic steatosis, the IAFT was 50,5 [30,7;65,0] mm and significantly increased with increasing hepatosis degree: from 45,0 [24,0;63,0] mm in respondents with grade 1 to 67,5 [34,0;76,0] mm with grade 3 (p=0,010). PFT also significantly increased from 11,5 [8,9;13,3] mm in individuals without hepatic steatosis to 13,8 [10,7;15,6] mm in those with grade 1, 18,5 [13,0;22,4] mm in those with grade 2 and 23,5 [13,0;29,4] mm in those with grade 3 hepatic steatosis (p=0,001). MinSAT and MaxSAT also increased, but not significantly (from 11,5 [8,8;15,9] to 20,4 [10,1;27,3] mm, p=0,151 and from 14,0 [11,4;25,4] mm to 22,4 [15,0;25,0] mm, p=0,576, respectively). The increase in WFI was also not significant. Linear regression analysis confirmed that hepatic steatosis was associated with IAFT increase (b=9,3, p=0,012).Conclusion. NAFLD is associated with factors influencing the CAD course — hyperglycemia, lipid metabolism disorders, as well as ultrasound markers of obesity. An increase in liver size was associated with an increase in BMI, glucose, triglycerides, high-density lipoproteins and ultrasound markers of obesity — IAFT and PFT. NAFLD in patients with CAD was associated with increased IAFT and PFT. In addition, 52,5% of people with normal body weight had NAFLD, which once again indicates the ineffectiveness of this indicator for stratifying the risk of development and progression of cardiovascular disease and the need for routine screening of NAFLD in people with cardiovascular diseases, regardless of BMI.

Keywords

• visceral obesity
• coronary heart disease
• non-alcoholic fatty liver disease
• abdominal fat depot
• ultrasound examination