Hepatic fibrosis assessed using transient elastography independently associated with coronary artery calcification

Abstract

Background and aim: Non-alcoholic fatty liver disease (NAFLD) has a close relationship with coronary atherosclerosis. We investigated the association between coronary atherosclerosis and liver fibrosis, represented as coronary artery calcification (CAC) score, and live stiffness (LS) value assessed using transient elastography (TE), respectively, in patients with NAFLD.

Methods: Between January 2013 and March 2014, a total of 285 asymptomatic subjects without chronic liver and ischemic heart diseases who underwent comprehensive medical health check-up were recruited. NAFLD was defined as controlled attenuation parameter (CAP) ≥ 250 dB/m on TE.

Results: The median age of the study population (men 161 and women 124) was 56 (interquartile [IQR], 50-63) years. Of these, 142 (49.8%) subjects had NAFLD. Among subjects with NAFLD, CAC score was independently correlated with the male gender (β = 0.230; P = 0.010), elevated erythrocyte sedimentation rate (β = 0.220; P = 0.019), reduced estimated glomerular filtration rate (β=-0.220; P = 0.004), increased left ventricular mass index (β = 0.226; P = 0.027), and higher LS values (β = 0.274; P < 0.001). In addition, alanine aminotransferase level (β = 0.214, P = 0.012) and CAC score (β = 0.311; P = 0.001) are the only independent factors associated with LS values in subjects with NAFLD.

Conclusions: Higher CAC score was independently correlated with LS values in subjects with NAFLD. However, it should be further investigated whether TE can be incorporated into a screening tool to identify the high-risk population for coronary artery disease.

Keywords: coronary artery calcification; fibroscan; healthy subjects; liver fibrosis; liver stiffness; nonalcoholic fatty liver disease; nonalcoholic steatohepatitis; transient elastography.