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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 5, September/October 2016
AFRICA
281
Gender-based differences in the relationship between
fatty liver disease and atherosclerosis
Hyun-Jin Kim, Chae-Wan Lim, Jae Hyuk Lee, Hyung-Bok Park, Yongsung Suh, Yoon-Hyeong Cho,
Tae-Young Choi, Eui-Seok Hwang, Deok-Kyu Cho
Abstract
Background:
Carotid intima–media thickness (CIMT) is a
surrogate of subclinical atherosclerosis. Fatty liver disease
is also linked to increased risk of cardiovascular events. The
aim of this study was to evaluate the association between fatty
liver disease and CIMT according to gender.
Methods:
Patients who had undergone carotid and abdomi-
nal ultrasound between June 2011 and December 2013 were
retrospectively evaluated. The differences between the CIMT
values measured in the common carotid artery and the preva-
lence of carotid plaque in patients with fatty liver disease and
those with normal livers were investigated.
Results:
Out of a total of 1 121 patients, the men had more
fatty liver disease than the women. The mean CIMT of the
men was significantly higher than that of the women, and the
men had more plaque than the women. The women with fatty
liver disease had a significantly higher mean CIMT value and
more plaque than the women with normal livers. The differ-
ences between the men with fatty liver and those with normal
livers in mean CIMT values and in the prevalence of plaque
were not significant. In the women, multivariate analysis
showed that fatty liver disease was independently associated
with subclinical atherosclerosis [adjusted hazards ratio (HR)
1.65, 95% confidence interval (CI) 1.007–2.697,
p
=
0.047].
Conclusions:
The men had more fatty liver disease, carotid
plaque and higher CIMT values than the women. Fatty liver
disease was a useful predictor of atherosclerosis, especially for
the female study patients.
Keywords:
carotid intima–media thickness, fatty liver, athero-
sclerosis
Submitted 13/1/16, accepted 17/2/16
Published online 14/3/16
Cardiovasc J Afr
2016;
27
: 281–286
www.cvja.co.zaDOI: 10.5830/CVJA-2016-014
Carotid intima–media thickness (CIMT) is a surrogate of
subclinical atherosclerosis and a predictor of cardiovascular
events.
1-3
Because CIMT can easily be estimated by ultra-
sonography, the assessment of CIMT is an effective means of
predicting cardiovascular events in asymptomatic patients.
4
In addition, for predicting cardiovascular risk, measuring
the thickness of the intima–media of the common carotid
artery plus evaluating whether or not plaque is present on the
ultrasound images have been suggested to be a good alternative
to ultrasound evaluation of all carotid artery segments.
5
Fatty liver disease is widely accepted as the hepatic expression
of the metabolic syndrome.
6
Patients with fatty liver disease have
an increased risk of cardiovascular events, and it was found to
be an independent risk factor of cardiovascular disease.
7-9
The
prevalence of fatty liver disease is different between men and
women and between younger and older individuals.
10
A previous
study found that the male gender was a risk factor for fatty liver
disease.
11
In addition, there are also gender and age differences in
the presence of carotid atherosclerosis.
4,5
Although fatty liver disease is linked to increased risk of
cardiovascular events, patients with fatty liver disease confirmed
by abdominal ultrasound are not always evaluated with regard
to atherosclerosis. To date, there are no specific guidelines
stipulating that patients with ultrasound-confirmed fatty liver
disease should undergo evaluation for subclinical atherosclerosis.
The aim of this study was to evaluate the association between
fatty liver disease and CIMT in patients stratified by gender.
Methods
Patients who visited the Healthcare Centre of the Myongji
Hospital in South Korea for routine check ups between June
2011 and December 2013 were screened retrospectively. Among
a total of 23 474 patients considered for inclusion in the study,
1 366 underwent both carotid and abdominal ultrasound. Of
these, the following patients with conditions that could lead to
chronic liver disease were excluded from the study: 60 patients
positive for hepatitis B surface antigen, six positive for hepatitis
C antibody, and 179 with excessive alcohol consumption (
≥
20
g/day)
12
(Fig. 1). A total of 1 121 patients were assessed in this
study.
The study was approved by the local institutional review
board and was conducted according to the Declaration of
Helsinki. Written informed patient consent was exempted by the
institutional review board.
Division of Cardiology, Department of Internal Medicine,
Myongji Hospital, Gyenggi-Do, South Korea
Hyun-Jin Kim, MD
Chae-wan Lim, MD
Jae hyuk Lee, MD
Hyung-Bok Park, MD
Yongsung Suh, MD
Yoon-Hyeong Cho, MD
Tae-Young Choi, MD
Eui-Seok Hwang, MD
Deok-Kyu Cho, MD,
chodk1234@daum.netDepartment of Translational Medicine, College of Medicine,
Seoul National University, Seoul, South Korea
Hyun-Jin Kim, MD