The severity of non-alcoholic fatty liver disease correlates with high sensitivity C-reactive protein value and is independently associated with increased cardiovascular risk in healthy population
Introduction
Non-alcoholic fatty liver disease (NAFLD) is hepatic infiltration by fat tissue. NAFLD has a wide spectrum, ranging from simple steatosis to more severe manifestation such as non-alcoholic steatohepatitis, which may lead to cirrhosis and hepatic failure [1]. The prevalence of NAFLD has been estimated at 10% to 39% in various populations [2], [3], [4], [5], [6], and increasing incidence worldwide was also observed. Subjects with fatty liver usually present variable degree of liver damage and variable cardiovascular (CV) risk factors such as obesity [7], type 2 diabetes, insulin resistance [8], hypertension [9] and metabolic syndrome (MtS) [10], [11]. Recently, Hamaguchi et al. demonstrated that coexistence of the CV risk factors may correlate with the severity of NAFLD [12] and suggested that non-alcoholic fatty liver disease (NAFLD) acts as the hepatic presentation of metabolic syndrome. Although NAFLD has been reported to be associated with cardiovascular risk factors and is considered an independent factor in determining cardiovascular events [13], [14], [15], there is still argument about whether NAFLD is an independent risk factor or merely a bystander of accumulating multiple cardiovascular disease risk factors [16], [17]. Is NAFLD a consequence of, or a contributor to, the dysmetabolic cascade leading to CVD? Does NAFLD promote atherosclerosis, or is it a simple epiphenomenon? In the conclusions of McKimmie and coauthors' study, NAFLD is less likely a direct mediator of cardiovascular disease (CVD) and may best be described as an epiphenomenon [18]. In addition, the connections between NAFLD and CVD were not consistent [19], and the independent association of fatty liver and CV risk may persist or disappear after adjusting for cardiovascular risk factors such as diabetes, or hypertension, suggesting the unclear role of fatty liver in cardiovascular disease. Therefore, our current study aimed to investigate the association between NAFLD and cardiovascular risk. We also investigate the association between NAFLD and other traditional CV risk factors.
Section snippets
Study subjects
A total of 833 subjects (733 men and 60 women) who received health examination at Taipei Veterans General Hospital between January 2007 and December 2007 were screened in this study. Subjects with major cardiovascular disease like stroke, myocardial infarction, coronary artery disease, or peripheral artery disease were excluded from the study. In addition, subjects were also excluded if they fulfilled the following criteria: (1) presence of serological markers of hepatitis B virus infection
Results
The baseline characteristics of study subjects are shown in Table 1. Compared with subjects without NAFLD, NAFLD subjects had significantly higher blood pressure, higher body mass index, increased waist circumference, and higher incidence of hypertension and diabetes as well as metabolic syndrome. In addition, NAFLD subjects had higher serum triglyceride and cholesterol levels, and lower HDL-C level. Subjects with NAFLD had higher hsCRP than those without NAFLD (1.9 mg/L vs. 1.4 mg/L, p = 0.047).
Discussion
Our study demonstrates non-obese and relatively healthy subjects with NAFLD have an increased risk of developing cardiovascular events. In addition, NAFLD is an independent risk factor for CVD. The severity of NAFLD correlates with increasing CV risks as well as underlying inflammatory status. Our study further demonstrates the risk-predictive value of NAFLD is most significant in aged subjects and in subjects with increased baseline hsCRP level, suggesting its novel value in identifying
Conclusion
Our study demonstrates that nonalcoholic liver disease is significantly associated with increased CV risk, especially among elderly subjects and subjects with increased baseline value of CRP.
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2015, Journal of Functional FoodsCitation Excerpt :Epidemiological reports have indicated that the prevalence of NAFLD is generally between 10 and 40% in various populations, and it is also the most common cause of abnormal results in liver function tests (el-Hassan, Ibrahim, al-Mulhim, Nabhan, & Chammas, 1992; Fan et al., 2005; Lonardo, Bellini, Tartoni, & Tondelli, 1997). Clinical studies have shown that NAFLD, a hepatic manifestation of the metabolic syndrome, is strongly associated with obesity, insulin resistance, enhanced systemic inflammation, advanced atherosclerosis, and also increased cardiovascular disease risk (Chiang, Huang, Chan, Chen, & Leu, 2010; Després et al., 2008; Kotronen & Yki-Jarvinen, 2008; Sung, Ryan, & Wilson, 2009; Tarantino, Saldalamacchia, Conca, & Arena, 2007). The National Cholesterol Education Panel (Expert Panel On Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, 2001) has established dietary therapy as the cornerstone of strategies to lower low density lipoprotein cholesterol (LDL-C) levels and reduce the risk of coronary artery disease (CAD).
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