Background & Aims
Non-alcoholic fatty liver disease (NAFLD) is highly prevalent and is associated with development of metabolic disease including atherosclerotic cardiovascular disease (CVD). Our aim is to examine the association of hepatic steatosis with prevalent clinical and subclinical CVD outcomes in a large community-based sample, the Framingham Heart Study.
Hepatic steatosis was measured in 3529 participants using multidetector computed tomography scanning. Multivariable logistic regression was used to determine whether hepatic steatosis is associated with prevalent CVD adjusted for covariates. We also tested whether associations were independent of other metabolic diseases/traits. The primary clinical outcome was composite prevalent clinical CVD defined by prior non-fatal myocardial infarction, stroke, transient ischemic attack, heart failure, or peripheral arterial disease. Subclinical cardiovascular outcomes were coronary artery calcium (CAC) and abdominal artery calcium (AAC).
3014 participants were included (50.5% women). There was a non-significant association of hepatic steatosis with clinical CVD (OR 1.14 [p = 0.07]). Hepatic steatosis was associated with both CAC and AAC (OR 1.20 [p <0.001] and OR 1.16 [p <0.001], respectively). Associations persisted for CAC even when controlling for other risk factors/metabolic diseases, but for AAC, the associations became non-significant after adjustment for visceral adipose tissue. The association between hepatic steatosis and AAC was stronger in men than in women (p sex interaction = 0.022).
There was a significant association of hepatic steatosis with subclinical CVD outcomes independent of many metabolic diseases/traits with a trend towards association between hepatic steatosis and clinical CVD outcomes. The association with AAC was stronger in men than in women.
Abbreviations:AAC (abdominal aortic calcium), ATP (Adult Treatment Panel), BMI (body mass index), CAC (coronary artery calcium), CHD (coronary heart disease), CT (computed tomography), CVD (cardiovascular disease), HDL (high-density lipoprotein), HRT (hormone replacement therapy), HTN (hypertension), MI (myocardial infarction), NAFLD (non-alcoholic fatty liver disease), NASH (non-alcoholic steatohepatitis), NCEP (National Cholesterol Education Program), PAD (peripheral arterial disease), RNA (ribonucleic acid), SAT (subcutaneous adipose tissue), TIA (transient ischemic attack), VAT (visceral adipose tissue)
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Published online: March 14, 2015
Accepted: February 26, 2015
Received in revised form: February 24, 2015
Received: April 7, 2014
© 2015 Published by Elsevier Inc.