Tsou Meng-Ting, Chen Jau-Yuan
Department of Family Medicine, Mackay Memorial Hospital, Taipei City, Taiwan.
Department of Occupation Medicine, Mackay Memorial Hospital, Taipei City, Taiwan.
Front Cardiovasc Med. 2022 Mar 3;9:803967. doi: 10.3389/fcvm.2022.803967. eCollection 2022.
It is not certain whether non-alcoholic fatty liver disease (NAFLD) or abdominal obesity (AO) has stronger associations with atherosclerosis and coronary artery disease (CAD) risk across different genders. The purpose of this study was to determine the gender-based association of NAFLD and AO with subclinical atherosclerosis represented by coronary artery calcification (CAC) and CAD risk by Framingham risk score (FRS).
A total of 1,655 participants in a health-screening program (mean age: 49.44 years; males: 70.33%) were enrolled for analysis. Fatty liver and coronary artery calcium score (CACS) were measured via ultrasonography (US) and multi-detector computed tomography (MDCT). The presence of CAC was defined as having a CACS > 0, intermediate to high CAD risk was defined as FRS ≥ 10%, while the presence of AO was defined as having a waist circumference (WC) of ≥90 cm for men and ≥80 cm for women. Participants were categorized into four groups depending on the presence or absence of NAFLD and/or AO.
The percentage of subjects with CACS > 0 was highest in the AO-only group (overall: 42.6%; men: 48.4%; women: 35.8%); and FRS ≥ 10% was highest in the group with both abnormalities (overall: 50.3%%; men: 57.3%; women: 32.4%). After adjustment factors, the odds ratio (OR) for CAC and FRS was the highest in the group with both abnormalities [men: 1.61 (1.13-2.30) for CACS > 0 and 5.86 (3.37-10.20) for FRS ≥ 10%; women: 2.17 (1.13-4.16) for CACS > 0 and 6.31 (2.08-19.10) for FRS ≥ 10%]. In men, the OR of NAFLD was higher than that of AO [1.37 (1.03-1.83) vs. 1.35 (1.02-1.79) for CACS > 0, 3.26 (2.13-4.98) vs. 2.97 (1.91-4.62) for FRS ≥ 10%]. However, women with AO consistently showed increased OR for CACS > 0 [1.87 (1.11-3.16)] and FRS ≥ 10% [4.77 (2.01-11.34)].
The degree of association of NAFLD and AO with CAC and FRS depends on the gender. NAFLD is more closely associated with CACS > 0 and FRS ≥ 10% in men and AO in women, respectively. NAFLD and AO could be considered independent determinants of CAC and FRS by gender.
非酒精性脂肪性肝病（NAFLD）或腹型肥胖（AO）与不同性别动脉粥样硬化及冠状动脉疾病（CAD）风险之间的关联强度尚不确定。本研究旨在确定NAFLD和AO与以冠状动脉钙化（CAC）为代表的亚临床动脉粥样硬化以及基于弗雷明汉风险评分（FRS）的CAD风险之间的性别差异关联。
共有1655名健康筛查项目参与者（平均年龄：49.44岁；男性：70.33%）纳入分析。通过超声检查（US）和多排螺旋计算机断层扫描（MDCT）测量脂肪肝和冠状动脉钙化评分（CACS）。CAC的存在定义为CACS>0，中度至高度CAD风险定义为FRS≥10%，而AO的存在定义为男性腰围（WC）≥90cm，女性≥80cm。根据是否存在NAFLD和/或AO将参与者分为四组。
仅AO组中CACS>0的受试者百分比最高（总体：42.6%；男性：48.4%；女性：35.8%）；两种异常情况并存组中FRS≥10%的比例最高（总体：50.3%；男性：57.3%；女性：32.4%）。调整因素后，两种异常情况并存组中CAC和FRS的比值比（OR）最高[男性：CACS>0时为1.61（1.13 - 2.30），FRS≥10%时为5.86（3.37 - 10.20）；女性：CACS>0时为2.17（1.13 - 4.16），FRS≥10%时为6.31（2.08 - 19.10）]。在男性中，NAFLD的OR高于AO[CACS>0时为1.37（1.03 - 1.83）对1.35（1.02 - 1.79），FRS≥10%时为3.26（2.13 - 4.98）对2.97（1.91 - 4.62）]。然而，患有AO的女性CACS>0[1.87（1.11 - 3.16）]和FRS≥10%[4.77（2.01 - 11.34）]的OR持续升高。
NAFLD和AO与CAC和FRS的关联程度取决于性别。NAFLD分别与男性CACS>0和FRS≥10%以及女性AO的关联更为密切。NAFLD和AO可被视为按性别划分的CAC和FRS的独立决定因素。
