Al Rifai Mahmoud, Silverman Michael G, Nasir Khurram, Budoff Matthew J, Blankstein Ron, Szklo Moyses, Katz Ronit, Blumenthal Roger S, Blaha Michael J
Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.
Atherosclerosis. 2015 Apr;239(2):629-33. doi: 10.1016/j.atherosclerosis.2015.02.011. Epub 2015 Feb 7.
We characterized the association of 3 metabolic conditions - obesity, metabolic syndrome, and nonalcoholic fatty liver disease (NAFLD) - with increased inflammation and subclinical atherosclerosis.
We conducted cross-sectional analysis of 3976 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with adequate CT imaging to diagnose NAFLD. Obesity was defined as BMI ≥ 30 kg/m(2), metabolic syndrome by AHA/NHLBI criteria, and NAFLD using non-contrast cardiac CT and a liver/spleen attenuation ratio (L/S) < 1. Increased inflammation was defined as high sensitivity C-reactive protein (hsCRP) ≥2 mg/L and subclinical atherosclerosis as coronary artery calcium (CAC) > 0. We studied the association of a stepwise increase in number of these metabolic conditions (0-3) with increased inflammation and CAC, stratifying results by gender and ethnicity.
Mean age of participants was 63 (±10) years, 45% were male, 37% white, 10% Chinese, 30% African American, and 23% were Hispanic. Adjusting for obesity, metabolic syndrome and traditional risk factors, NAFLD was associated with a prevalence odds ratio for hsCRP ≥2 mg/L and CAC >0 of 1.47 (1.20-1.79) and 1.37 (1.11-1.68) respectively. There was a positive interaction between female gender and NAFLD in the association with hsCRP ≥2 mg/L (p = 0.006), with no interaction by race. With increasing number of metabolic conditions, there was a graded increase in prevalence odds ratios of hsCRP ≥2 mg/L and CAC >0.
NAFLD is associated with increased inflammation and CAC independent of traditional risk factors, obesity and metabolic syndrome. There is a graded association between obesity, metabolic syndrome, and NAFLD with inflammation and CAC.
我们对肥胖、代谢综合征和非酒精性脂肪性肝病（NAFLD）这三种代谢状况与炎症增加和亚临床动脉粥样硬化之间的关联进行了特征描述。
我们对来自动脉粥样硬化多族裔研究（MESA）的3976名参与者进行了横断面分析，这些参与者有足够的CT影像来诊断NAFLD。肥胖定义为体重指数（BMI）≥30kg/m²，代谢综合征根据美国心脏协会（AHA）/美国国立心肺血液研究所（NHLBI）标准判定，NAFLD则通过非增强心脏CT及肝脏/脾脏衰减比（L/S）<1来诊断。炎症增加定义为高敏C反应蛋白（hsCRP）≥2mg/L，亚临床动脉粥样硬化定义为冠状动脉钙化（CAC）>0。我们研究了这些代谢状况数量逐步增加（0 - 3种）与炎症增加及CAC之间的关联，并按性别和种族对结果进行分层。
参与者的平均年龄为63（±10）岁，45%为男性，37%为白人，10%为华裔，30%为非裔美国人，23%为西班牙裔。在对肥胖、代谢综合征和传统风险因素进行校正后，NAFLD与hsCRP≥2mg/L及CAC>0的患病率比值比分别为1.47（1.20 - 1.79）和1.37（1.11 - 1.68）。在与hsCRP≥2mg/L的关联中，女性性别与NAFLD之间存在正向交互作用（p = 0.006），种族之间无交互作用。随着代谢状况数量的增加，hsCRP≥2mg/L及CAC>0的患病率比值比呈分级增加。
NAFLD与炎症增加及CAC相关，且独立于传统风险因素、肥胖和代谢综合征。肥胖、代谢综合征和NAFLD与炎症及CAC之间存在分级关联。
