Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Diabetes Care. 2012 Nov;35(11):2359-64. doi: 10.2337/dc12-0515. Epub 2012 Jul 24.
Nonalcoholic fatty liver disease (NAFLD) coexists with insulin resistance (IR), but it is uncertain whether NAFLD and IR contribute independently to atherosclerosis. We tested whether fatty liver, IR, and metabolic syndrome (MetS) features (waist, glucose, triglyceride, HDL cholesterol [HDL-C], and blood pressure) were associated with a marker of atherosclerosis (coronary artery calcium [CAC] score >0), independently of cardiovascular risk factors and cardiovascular disease (CVD).
Data were analyzed from a South Korean occupational cohort of 10,153 people who all received ultrasound measurements of fatty liver and a cardiac computed tomography CAC score. IR was defined by homeostasis model assessment of IR (HOMA-IR) ≥75th percentile. Odds ratios (ORs) (95% CIs) for the presence of a CAC score >0 were estimated using logistic regression.
There were 915 people with a CAC score >0. MetS features were increased (glucose, blood pressure, triglyceride, and waist) or decreased (HDL-C) among people with a CAC score >0 (all comparisons against CAC score ≤0; P < 0.0001). Of subjects with a CAC score >0, 55% had fatty liver and 33.7% were insulin resistant. Fatty liver (OR 1.21 [95% CI 1.01-1.45]; P = 0.04) and HOMA-IR (1.10 [1.02-1.18]; P = 0.02) were associated with CAC score >0, independently of all MetS features, conventional cardiovascular risk factors, and prior evidence of CVD. The presence of IR and fatty liver combined was associated with CAC score >0 (1.53 [1.20-1.95]; P = 0.001).
Fatty liver and HOMA-IR are both associated with a CAC score >0 (independently of each other), features of MetS, conventional cardiovascular risk factors, and existing CVD.
非酒精性脂肪性肝病（NAFLD）与胰岛素抵抗（IR）并存，但尚不确定 NAFLD 和 IR 是否独立促进动脉粥样硬化。我们检测了脂肪肝、IR 和代谢综合征（MetS）特征（腰围、血糖、甘油三酯、高密度脂蛋白胆固醇 [HDL-C] 和血压）与动脉粥样硬化标志物（冠状动脉钙 [CAC] 评分 >0）的相关性，是否独立于心血管危险因素和心血管疾病（CVD）。
对韩国职业队列的 10153 名参与者进行了数据分析，这些人都接受了脂肪肝超声检查和心脏计算机断层扫描 CAC 评分检查。IR 通过稳态模型评估的胰岛素抵抗（HOMA-IR）≥75 百分位数来定义。使用逻辑回归估计 CAC 评分 >0 的存在的比值比（OR）（95%CI）。
共有 915 人 CAC 评分 >0。CAC 评分 >0 的人群中 MetS 特征增加（血糖、血压、甘油三酯和腰围）或降低（HDL-C）（与 CAC 评分 ≤0 的所有比较；均 P <0.0001）。在 CAC 评分 >0 的人群中，55%有脂肪肝，33.7%有胰岛素抵抗。脂肪肝（OR 1.21 [95%CI 1.01-1.45]；P = 0.04）和 HOMA-IR（1.10 [1.02-1.18]；P = 0.02）与 CAC 评分 >0 独立相关，独立于所有 MetS 特征、传统心血管危险因素和先前 CVD 的证据。IR 和脂肪肝的同时存在与 CAC 评分 >0 相关（1.53 [1.20-1.95]；P = 0.001）。
脂肪肝和 HOMA-IR 均与 CAC 评分 >0 相关（相互独立），与 MetS 特征、传统心血管危险因素和现有的 CVD 相关。
