Guy's & St Thomas' NHS Foundation Trust, London, UK.
Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK.
Hepatol Commun. 2023 Mar 30;7(4). doi: 10.1097/HC9.0000000000000087. eCollection 2023 Apr 1.
Non-alcoholic fatty liver disease shares many risk factors with other metabolic disorders. We sought to establish whether non-alcoholic fatty liver disease may be associated with cardiovascular health independently of other known risk factors.
In this prospective, population-based cohort of young adults, controlled attenuation parameter-defined liver steatosis, transient elastography-defined liver fibrosis, echocardiography, carotid ultrasonography, and pulse wave analysis were assessed at age 24 years. We examined associations between liver and cardiovascular measures, with and without accounting for demographics, body mass index, alcohol, smoking, blood pressure, lipidemia, glycemia, and inflammation.
We included 2047 participants (mean age 24.4 y; 36.2% female): 212 (10.4%) had steatosis, whereas 38 (1.9%) had fibrosis. Steatosis was associated with cardiovascular measures after adjusting for demographics, but with more comprehensive adjustment, steatosis only remained associated with stroke index [β (95% CI) of -1.85 (-3.29, -0.41) mL/m2] and heart rate [2.17 (0.58, 3.75) beats/min]. Fibrosis was associated with several measures of cardiovascular structure and function after full adjustment for risk factors, including left ventricular mass index [2.46 (0.56, 4.37) g/m2.7], E/A ratio [0.32 (0.13, 0.50)], tricuspid annular plane systolic excursion [0.14 (0.01, 0.26) cm], carotid intima-media thickness [0.024 (0.008, 0.040) mm], pulse wave velocity [0.40 (0.06, 0.75) m/s], cardiac index [-0.23 (-0.41, -0.06) L/min⋅m2], and heart rate [-7.23 (-10.16, -4.29) beats/min].
Steatosis was not associated with measures of cardiovascular structure and function nor with subclinical atherosclerosis after adjusting for known cardiovascular risk factors. Fibrosis, however, was associated with several cardiovascular measures, including indicators of subclinical atherosclerosis, even after full adjustment. Further follow-up will help determine whether cardiovascular health worsens later with steatosis alone.
非酒精性脂肪性肝病与其他代谢紊乱有许多共同的危险因素。我们试图确定非酒精性脂肪性肝病是否可能与其他已知的危险因素无关，而与心血管健康有关。
在这项针对年轻人的前瞻性、基于人群的队列研究中，在 24 岁时评估了受控衰减参数定义的肝脂肪变性、瞬时弹性成像定义的肝纤维化、超声心动图、颈动脉超声和脉搏波分析。我们检查了肝脏和心血管测量值之间的关联，包括和不包括人口统计学、体重指数、酒精、吸烟、血压、血脂、血糖和炎症等因素。
我们纳入了 2047 名参与者（平均年龄 24.4 岁；36.2%为女性）：212 名（10.4%）有脂肪变性，38 名（1.9%）有纤维化。在调整了人口统计学因素后，脂肪变性与心血管指标相关，但在更全面的调整后，脂肪变性仅与卒中指数[β（95%CI）-1.85（-3.29，-0.41）mL/m2]和心率[2.17（0.58，3.75）次/分]相关。纤维化在充分调整危险因素后与心血管结构和功能的几个指标相关，包括左心室质量指数[2.46（0.56，4.37）g/m2.7]、E/A 比值[0.32（0.13，0.50）]、三尖瓣环平面收缩期位移[0.14（0.01，0.26）cm]、颈动脉内膜中层厚度[0.024（0.008，0.040）mm]、脉搏波速度[0.40（0.06，0.75）m/s]、心指数[-0.23（-0.41，-0.06）L/min·m2]和心率[-7.23（-10.16，-4.29）次/分]。
在调整了已知的心血管危险因素后，脂肪变性与心血管结构和功能的指标以及亚临床动脉粥样硬化均无相关性。然而，纤维化与多个心血管指标相关，包括亚临床动脉粥样硬化的指标，即使在充分调整后也是如此。进一步的随访将有助于确定单纯脂肪变性是否会导致心血管健康状况恶化。
