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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2005;25:1045.)
© 2005 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Nonalcoholic Fatty Liver Disease Is Associated With Carotid Atherosclerosis

A Case–Control Study

Angel Brea; Daniel Mosquera; Eva Martín; Ana Arizti; José L. Cordero; Emilio Ros

From the Lipid Clinic, Internal Medicine Service (A.B., D.M., E.M., A.A.) and Radiology Service (J.L.C.), Hospital San Millán-San Pedro, Logroño, Spain; and Lipid Clinic, Endocrinology and Nutrition Service, Institut d’Investigacions Biomèdiques August Pi Sunyer, Hospital Clínico, Barcelona (E.R.), Spain.

Correspondence to Angel Brea, MD, Lipid Clinic, Internal Medicine Service, Hospital San Millán-San Pedro, Autonomía de la Rioja 4, 26004 Logroño, Spain. E-mail a.brea{at}arrakis.es

Objective— Nonalcoholic fatty liver disease (NAFLD) frequently coexists with obesity, diabetes, and dyslipidemia. We examined whether NAFLD was associated with atherosclerosis, as measured by ultrasound in the carotid arteries.

Methods and Results— Carotid atherosclerosis and cardiovascular risk factors were assessed in 40 patients with an ultrasound diagnosis of primary NAFLD and 40 matched population controls. The metabolic syndrome and all its individual traits, including elevated C-reactive protein, were significantly (P<0.005) more frequent in NAFLD patients than in control subjects. Patients with NAFLD showed more carotid atherosclerosis than controls, with mean intima-media thickness (IMT) of 0.70±0.20 mm and 0.54±0.13 mm (P<0.0001) and plaque prevalence of 50% and 25% (P=0.021), respectively. By multivariate analysis, older age (odds ratio [OR], 2.5 per 10 years; 95% CI, 1.4 to 4.4; P=0.002), the presence of NAFLD (OR, 8.4; 95% CI, 2.49 to 29.4; P=0.001), and elevated serum ferritin (OR, 3.1; 95% CI, 1.2 to 7.9; P=0.016) were independent predictors of an increased IMT.

Conclusions— Patients with NAFLD show a cluster of risk factors of the metabolic syndrome and advanced carotid atherosclerosis. NAFLD appears to be a feature of the metabolic syndrome, and its detection on abdominal ultrasound should alert to the existence of an increased cardiovascular risk.

In a case–control study, we examined whether nonalcoholic patients with an ultrasound diagnosis of fatty liver had carotid atherosclerosis. Compared with controls, cases showed increased intima-media thickness and plaque prevalence. The casual detection of a fatty liver by abdominal ultrasound should alert to the existence of a high cardiovascular risk.

Key Words: atherosclerosis • metabolic syndrome • nonalcoholic fatty liver • inflammation • cardiovascular risk factors • carotid ultrasound

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