Ahmed Mohamed H, Barakat Salma, Almobarak Ahmed O
Department of Medicine, Wexham Park Hospital, Berkshire, Slough, UK.
J Obes. 2012;2012:483135. doi: 10.1155/2012/483135. Epub 2012 Dec 23.
Nonalcoholic fatty liver disease (NAFLD) is prevalent in people with the metabolic syndrome and type 2 diabetes and is present in up to one-third of the general population. Evidence is now accumulating that NAFLD is associated with obesity and diabetes and may serve as a predictor of cardiovascular disease (CVD). The possible mechanisms linking NAFLD and CVD include inflammation and oxidative stress, hyperlipidaemia, insulin resistance, and direct impact of NAFLD on coronary arteries and left ventricular dysfunction. In addition, several studies suggest that NAFLD is associated with high risk of CVD and atherosclerosis such as carotid artery wall thickness and lower endothelial flow-mediated vasodilation independently of classical risk factors and components of the metabolic syndrome. It is not yet clear how treatment of NAFLD will modulate the risk of CVD. Furthermore, studies are urgently needed to establish (i) the pathophysiology of CVD with NAFLD and (ii) the benefit of early diagnosis and treatment of CVD in patients with NAFLD. In the absence of biochemical markers, it is crucial that screening and surveillance strategies are adopted in clinical practice in the growing number of patients with NAFLD and at risk of developing CVD. Importantly, the current evidence suggest that statins are safe and effective treatment for CVD in individuals with NAFLD.
非酒精性脂肪性肝病（NAFLD）在代谢综合征和2型糖尿病患者中很常见，在普通人群中患病率高达三分之一。目前越来越多的证据表明，NAFLD与肥胖和糖尿病相关，可能是心血管疾病（CVD）的一个预测指标。NAFLD与CVD之间可能的联系机制包括炎症和氧化应激、高脂血症、胰岛素抵抗，以及NAFLD对冠状动脉和左心室功能障碍的直接影响。此外，多项研究表明，NAFLD与CVD和动脉粥样硬化的高风险相关，如颈动脉壁厚度增加和内皮依赖性血流介导的血管舒张降低，且独立于经典危险因素和代谢综合征的组成成分。目前尚不清楚NAFLD的治疗将如何调节CVD风险。此外，迫切需要开展研究以确定：（i）伴有NAFLD的CVD的病理生理学；（ii）NAFLD患者早期诊断和治疗CVD的益处。在缺乏生化标志物的情况下，对越来越多的NAFLD患者以及有发生CVD风险的患者在临床实践中采用筛查和监测策略至关重要。重要的是，目前的证据表明，他汀类药物是治疗伴有NAFLD个体CVD的安全有效药物。
