VanWagner Lisa B, Ning Hongyan, Lewis Cora E, Shay Christina M, Wilkins John, Carr J Jeffrey, Terry James G, Lloyd-Jones Donald M, Jacobs David R, Carnethon Mercedes R
Department of Preventive Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Preventive Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Atherosclerosis. 2014 Aug;235(2):599-605. doi: 10.1016/j.atherosclerosis.2014.05.962. Epub 2014 Jun 10.
Non-alcoholic fatty liver disease (NAFLD) is an obesity-related condition associated with cardiovascular mortality. Yet, whether or not NAFLD is independently related to atherosclerosis is unclear. In a population-based cross-sectional sample of middle-aged adults free from liver or heart disease, we tested the hypothesis that NAFLD is associated with subclinical atherosclerosis (coronary artery (CAC) and abdominal aortic calcification (AAC)) independent of obesity.
Participants from the Coronary Artery Risk Development in Young Adults study with CT quantification of liver fat, CAC and AAC were included (n = 2424). NAFLD was defined as liver attenuation ≤40 Hounsfield Units after exclusion of other causes of liver fat. CAC and AAC presence was defined as Agatston score >0.
Mean participant age was 50.1 ± 3.6 years, (42.7% men, 50.0% black) and BMI was 30.6 ± 7.2 kg/m(2). The prevalence of NAFLD, CAC, and AAC was 9.6%, 27.1%, and 51.4%. NAFLD participants had increased prevalence of CAC (37.9% vs. 26.0%, p < 0.001) and AAC (65.1% vs. 49.9%, p < 0.001). NAFLD remained associated with CAC (OR, 1.33; 95% CI, 1.001-1.82) and AAC (OR, 1.74; 95% CI, 1.29-2.35) after adjustment for demographics and health behaviors. However, these associations were attenuated after additional adjustment for visceral adipose tissue (CAC OR, 1.05; 95% CI, 0.74-1.48, AAC OR = 1.20; 95% CI, 0.86-1.67). There was no interaction by race or sex.
In contrast to prior research, these findings suggest that obesity attenuates the relationship between NAFLD and subclinical atherosclerosis. Further studies evaluating the role of NAFLD duration on atherosclerotic progression and cardiovascular events are needed.
非酒精性脂肪性肝病（NAFLD）是一种与肥胖相关的疾病，与心血管疾病死亡率相关。然而，NAFLD是否与动脉粥样硬化独立相关尚不清楚。在一个基于人群的无肝脏或心脏病的中年成年人横断面样本中，我们检验了NAFLD与亚临床动脉粥样硬化（冠状动脉钙化（CAC）和腹主动脉钙化（AAC））独立于肥胖相关的假设。
纳入来自青年成人冠状动脉风险发展研究中对肝脏脂肪、CAC和AAC进行CT定量分析的参与者（n = 2424）。NAFLD定义为排除其他肝脏脂肪原因后肝脏衰减≤40亨氏单位。CAC和AAC的存在定义为阿加斯顿评分>0。
参与者的平均年龄为50.1±3.6岁（男性占42.7%，黑人占50.0%），BMI为30.6±7.2kg/m²。NAFLD、CAC和AAC的患病率分别为9.6%、27.1%和51.4%。NAFLD参与者的CAC患病率（37.9%对26.0%，p<0.001）和AAC患病率（65.1%对49.9%，p<0.001）增加。在对人口统计学和健康行为进行调整后，NAFLD仍与CAC（OR，1.33；95%CI，1.001 - 1.82）和AAC（OR，1.74；95%CI，1.29 - 2.35）相关。然而，在对内脏脂肪组织进行额外调整后，这些关联减弱（CAC的OR，1.05；95%CI，0.74 - 1.48，AAC的OR = 1.20；95%CI，0.86 - 1.67）。不存在种族或性别的交互作用。
与先前的研究相反，这些发现表明肥胖减弱了NAFLD与亚临床动脉粥样硬化之间的关系。需要进一步研究评估NAFLD病程对动脉粥样硬化进展和心血管事件的作用。
