Background & Aims
Whether steatosis is incidentally or causally associated with carotid atherosclerosis
is debated, and long-term follow-up data are missing. This study aims to examine the
impact of steatosis on the presence and progression of carotid intima-media thickness
(C-IMT) and carotid plaques (CP) in a large cohort with longitudinal follow-up.
Methods
A retrospective single-center study between 1995 and 2012. Transversal cohort: patients
with ⩾2 cardiovascular risk factors without previous cardiovascular events. Longitudinal
cohort: patients with two consecutive C-IMT measurements more than 2 years apart. Steatosis was defined by a surrogate marker, the fatty liver index (FLI).
CP and C-IMT were assessed by carotid ultrasound.
Results
In the transversal cohort (n = 5671) both C-IMT and the Framingham risk score (FRS) increased across FLI quartiles
(0.58 ± 0.12, 0.61 ± 0.14, 0.63 ± 0.14, 0.64 ± 0.14 mm, and 5 ± 5%, 9 ± 7%, 12 ± 8%, 15 ± 9%, p <0.001 for both). Steatosis predicted C-IMT better than diabetes or dyslipidemia.
Steatosis independently predicted C-IMT (p = 0.002) and FRS (p <0.001) after adjustment for metabolic syndrome and cardiovascular risk factors.
In the longitudinal cohort (n = 1872, mean follow-up 8 ± 4 years), steatosis occurred in 12% and CP in 23% of patients. C-IMT increased in patients
with steatosis occurrence (from 0.60 ± 0.13 mm to 0.66 ± 0.14 mm, p = 0.001) whereas it did not change in those that stayed free of steatosis. Steatosis
at baseline predicted CP occurrence (OR = 1.63, 95% CI 1.10–2.41, p = 0.014), independent of age, sex, type-2 diabetes, tobacco use, hsCRP, hypertension
and C-IMT.
Conclusions
In patients with metabolic syndrome at risk for cardiovascular events, steatosis contributes
to early atherosclerosis and progression thereof, independent of traditional cardiovascular
risk factors.
Graphical abstract
Graphical Abstract
Abbreviations:
C-IMT (carotid intima-media thickness), FLI (fatty liver index), NAFLD (non-alcoholic fatty liver disease), FRS (10year Framingham risk score)Keywords
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Article info
Publication history
Published online: April 26, 2016
Accepted:
February 4,
2016
Received in revised form:
January 17,
2016
Received:
August 30,
2015
See Editorial, pages 14–16Identification
Copyright
© 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
