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      Nonalcoholic fatty liver disease as an independent risk factor for carotid atherosclerosis

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          Abstract

          PURPOSE:

          Nonalcoholic fatty liver disease (NAFLD) is a frequently encountered clinical condition in clinical practice, particularly in obese and diabetic patients. Carotid atherosclerosis is regarded as surrogate marker of coronary atherosclerosis. We aimed to know whether evaluation for carotid atherosclerosis should be done in all patients of NAFLD.

          MATERIALS AND METHODS:

          A total of 200 NAFLD patients and 100 age- and sex-matched controls were enrolled into the study. Ultrasound was done to document fatty liver and carotid intimal thickness, and relation between these two was observed.

          RESULTS:

          Grade 1 fatty liver was seen in 36% patients while Grade 2 fatty liver was found in 39% and Grade 3 fatty liver in 25%. Patients with Grade 1 fatty liver had left intima-media thickness (IMT) in the range of 0.4–0.6 mm (mean IMT - 0.69 mm) and had right IMT in the range of 0.5–0.8 mm (mean IMT - 0.71 mm). In patients with Grade 2 fatty liver, left IMT was in the range of 0.6–1.0 mm (mean IMT - 0.80 mm) and right IMT in the range of 0.7–1.0 mm (mean IMT - 0.84 mm), while in patients with Grade 3 fatty liver, left IMT was in the range of 0.8–1.2 mm (mean IMT - 0.93 mm) and right IMT in the range of 0.9–1.4 mm (mean IMT - 0.99 mm). Among controls, the mean left IMT was 0.579 mm and mean right IMT was 0.575 mm.

          CONCLUSION:

          The level of carotid intimomedial thickness was more in cases than in controls and progressively increased with the grade of fatty liver which was statistically significant.

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          Most cited references13

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          Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study.

          Michiel L. Bots, Arno Hoes, Peter J Koudstaal … (1997)
          Noninvasive assessment of intima-media thickness (IMT) is widely used in observational studies and trials as an intermediate or proxy end point for cardiovascular disease. However, data showing that IMT predicts cardiovascular disease are limited. We studied whether common carotid IMT is related to future stroke and myocardial infarction. We used a nested case-control approach among 7983 subjects aged > or =55 years participating in the Rotterdam Study. At baseline (March 1990 through July 1993), ultrasound images of the common carotid artery were stored on videotape. Determination of incident myocardial infarction and stroke was predominantly based on hospital discharge records. Analysis (logistic regression) was based on 98 myocardial infarctions and 95 strokes that were registered before December 31, 1994. IMT was measured from videotape for all case subjects and a sample of 1373 subjects who remained free from myocardial infarction and stroke during follow-up. The mean duration of follow-up was 2.7 years. Results were adjusted for age and sex. Stroke risk increased gradually with increasing IMT. The odds ratio for stroke per standard deviation increase (0.163 mm) was 1.41 (95% CI, 1.25 to 1.82). For myocardial infarction, an odds ratio of 1.43 (95% CI, 1.16 to 1.78) was found. When subjects with a previous myocardial infarction or stroke were excluded, odds ratios were 1.57 (95% CI, 1.27 to 1.94) for stroke and 1.51 (95% CI, 1.18 to 1.92) for myocardial infarction. Additional adjustment for several cardiovascular risk factors attenuated these associations: 1.34 (95% CI, 1.08 to 1.67) and 1.25 (95% CI, 0.98 to 1.58), respectively. The present study, based on a short follow-up period, provides evidence that an increased common carotid IMT is associated with future cerebrovascular and cardiovascular events.
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            Mannheim Carotid Intima-Media Thickness Consensus (2004–2006)

            P.-J. Touboul, M.G. Hennerici, S Meairs … (2007)
            Intima-media thickness (IMT) is increasingly used as a surrogate end point of vascular outcomes in clinical trials aimed at determining the success of interventions that lower risk factors for atherosclerosis and associated diseases (stroke, myocardial infarction and peripheral artery diseases). The necessity to promote further criteria to distinguish early atherosclerotic plaque formation from thickening of IMT and to standardize IMT measurements is expressed through this updated consensus. Plaque is defined as a focal structure that encroaches into the arterial lumen of at least 0.5 mm or 50% of the surrounding IMT value or demonstrates a thickness >1.5 mm as measured from the media-adventitia interface to the intima-lumen interface. Standard use of IMT measurements is based on physics, technical and disease-related principles as well as agreements on how to perform, interpret and document study results. Harmonization of carotid image acquisition and analysis is needed for the comparison of the IMT results obtained from epidemiological and interventional studies around the world. The consensus concludes that there is no need to ‘treat IMT values’ nor to monitor IMT values in individual patients apart from exceptions named, which emphasize that inside randomized clinical trials should be performed. Although IMT has been suggested to represent an important risk marker, according to the current evidence it does not fulfill the characteristics of an accepted risk factor. Standardized methods recommended in this consensus statement will foster homogenous data collection and analysis. This will help to improve the power of randomized clinical trials incorporating IMT measurements and to facilitate the merging of large databases for meta-analyses.
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              The role of carotid arterial intima-media thickness in predicting clinical coronary events.

              Howard Hodis (1998)
              Carotid arterial intima-media thickness is used as a noninvasive surrogate end point to measure progression of atherosclerosis, but its relation to coronary events has not been fully explored. To determine whether carotid arterial intima-media thickness predicts coronary events. Long-term follow-up (average, 8.8 years) of a previously assembled cohort of persons who completed the 2-year Cholesterol Lowering Atherosclerosis Study, a randomized arterial imaging trial designed to study the effects of lipid lowering on progression of atherosclerosis. University-based ultrasonography laboratory. 146 men 40 to 59 years of age who had previously had coronary artery bypass graft surgery. Preintrusive atherosclerosis in the common carotid artery was evaluated every 6 months with B-mode ultrasonography, and intrusive atherosclerosis in the coronary arteries was evaluated at baseline and at 2 years with quantitative coronary angiography. After the trial, the incidences of coronary events (nonfatal acute myocardial infarction, coronary death, and coronary artery revascularization) were documented. For each 0.03-mm increase per year in carotid arterial intima-media thickness, the relative risk for nonfatal myocardial infarction or coronary death was 2.2 (95% CI, 1.4 to 3.6) and the relative risk for any coronary event was 3.1 (CI, 2.1 to 4.5) (P < 0.001). Absolute intima-media thickness was also related to risk for clinical coronary events (P < 0.02). Absolute thickness and progression in thickness predicted risk for coronary events beyond that predicted by coronary arterial measures of atherosclerosis and lipid measurements (P < 0.001). Noninvasive B-mode ultrasonographic measurement of progression of intima-media thickness in the distal common carotid artery is a useful surrogate end point for clinical coronary events.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Brain Circ
                Journal ID (iso-abbrev): Brain Circ
                Journal ID (publisher-id): BC
                Title: Brain Circulation
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2394-8108
                ISSN (Electronic): 2455-4626
                Publication date (Print): Jan-Mar 2017
                Publication date (Electronic): 29 March 2017
                Volume: 3
                Issue: 1
                Pages: 35-40
                Affiliations
                [1] Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
                Author notes
                Address for correspondence: Dr. Waseem Dar, Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India. E-mail: drwaseem.mw@ 123456gmail.com
                Article
                Publisher ID: BC-3-35
                DOI: 10.4103/bc.bc_28_16
                PMC ID: 6126233
                PubMed ID: 30276302
                SO-VID: 0d190ec1-d754-4e34-8b6b-8ca0506090d7
                Copyright © Copyright: © 2017 Brain Circulation
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 25 December 2016
                Date revision received : 30 January 2017
                Date accepted : 21 February 2017
                Categories
                Subject: Original Article

                Keywords: atherosclerosis,fatty liver,intimomedial thickness
                Data availability:
                Keywords: atherosclerosis, fatty liver, intimomedial thickness

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