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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2005;25:e117.)
© 2005 American Heart Association, Inc.

Letters to the Editor

Nonalcoholic Fatty Liver Disease and Atherosclerosis

Giovanni Targher

Division of Internal Medicine and Diabetes Unit Ospedale "Sacro Cuore – don G. Calabria", Negrar (VR), Italy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

I read with interest the article by Brea et al¹ regarding the strong relationship between nonalcoholic fatty liver disease (NAFLD) and carotid atherosclerosis (as measured by intima-media thickness [IMT] and plaque prevalence) in a sample of predominantly obese and hypertensive subjects.

Notably, they reported substantially similar results to those recently published by our group in a sample of nonobese healthy men,² thus further supporting the notion that people with NAFLD are at increased risk of CVD.

However, I partly disagree with the authors’ conclusions suggesting that NAFLD is a strong risk factor for carotid atherosclerosis beyond its association with the metabolic syndrome (MetS).

In both studies, patients with NAFLD had, other than several features resembling MetS, a marked increase in carotid IMT values compared with those without NAFLD. However, in the study by Brea et al¹ the increase in carotid IMT (but not that in the prevalence of carotid plaques) remained statistically significant after adjustment for the presence of MetS (as defined by ATP-III or WHO criteria). On the contrary, in our study the increase in carotid IMT was largely mediated by the extent of visceral fat accumulation, as measured by computed tomography (CT).² It is known that WHO and ATP-III definitions of MetS include waist circumference (or waist/hip ratio) among their diagnostic criteria. However, it is also known that waist circumference provides only an indirect and crude estimation of visceral fat,³ so we cannot be certain that the results of the study by Brea et al . . . [Full Text of this Article]

Angel Brea

Lipid Clinic, Internal Medicine Service Hospital San Millán-San Pedro Logroño, Spain

Emilio Ros

Lipid Clinic, Endocrinology and Nutrition Service Institut d’Investigacions Biomediques August Pi Sunyer Hospital Clínico Barcelona, Spain