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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 5, September/October 2016
284
AFRICA
0.034) were independent predictors of subclinical atherosclerosis
in men. Univariate analysis showed that fatty liver disease, larger
waist circumference, older age and history of hypertension
were associated with subclinical atherosclerosis in women.
Multivariate analysis found that fatty liver disease was an
independent predictor of subclinical atherosclerosis in women
(HR 1.65, 95% CI: 1.007–2.697,
p
=
0.047). Older age (HR 1.08,
95% CI: 1.056–1.107,
p
>
0.001) and hypertension (HR 1.82, 95%
CI: 1.135–2.902,
p
=
0.013) were also independent predictors of
subclinical atherosclerosis in women.
Although a significantly higher proportion of men aged 60
years and under had fatty liver disease than the women (Fig.
2A), fatty liver disease was significantly associated with increased
CIMT or plaque formation in women aged 60 and under (HR
2.13, 95% CI: 1.268–3.562,
p
=
0.004). The association between
fatty liver disease and subclinical atherosclerosis in men aged 60
and under was not significant (HR 1.10, 95% CI: 0.753–1.608,
p
=
0.620). Moreover, although there was no difference in the
prevalence of fatty liver disease between the male and female
patients older than 60 years, women with fatty liver disease
tended to have subclinical atherosclerosis (HR 1.85, 95% CI:
0.929–3.683,
p
=
0.080). Fatty liver disease in older men was not
associated with subclinical atherosclerosis (HR 1.35, 95% CI:
0.647–2.803,
p
=
0.456).
Discussion
The prevalence of fatty liver disease was higher in the men
than the women in our study, especially in patients aged 60
years and under. The mean CIMT value was higher and the
presence of plaque was more in men than women, regardless of
age. Interestingly, a significantly higher mean CIMT value was
found in the women with fatty liver disease than in the women
with normal livers, and women with fatty liver had more carotid
plaque than women with normal livers. Fatty liver disease was
independently associated with subclinical atherosclerosis in the
women only, which was defined as a higher CIMT value (
≥
75th
percentile
≥
0.88 mm) or presence of carotid plaque.
CIMT values and the prevalence of carotid plaque increased
with age for both genders in our study cohort. The differences
in CIMT values between genders persisted for all age groups,
and the differences in the prevalence of plaque between genders
persisted for groups of study patients. These results are consistent
with the findings of the Gutenberg Heart study, in which early
Table 3. CIMT and percentage of subjects with carotid plaques according to binary risk factors
Men (
n
=
630)
Women (
n
=
491)
Variable
CIMT (mm)
p
-value
Presence of
plaque (%)
p
-value
CIMT (mm)
p
-value
Presence of
plaque (%)
p
-value
Waist circumference
0.101
0.185
<
0.001
0.001
≥
90 cm (M),
≥
80 cm (W)
0.81
±
0.16
26.7
0.80
±
0.17
27.7
<
90 cm (M),
<
80 cm (W)
0.79
±
0.17
32.2
0.73
±
0.17
15.4
History of hypertension
0.007
<
0.001
<
0.001
<
0.001
Yes
0.82
±
0.16
42.9
0.81
±
0.15
35.5
No
0.78
±
0.17
24.3
0.73
±
0.17
13.1
History of diabetes
0.001
<
0.001
<
0.001
<
0.001
Yes
0.85
±
0.15
46.2
0.83
±
0.16
43.1
No
0.78
±
0.17
27.4
0.75
±
0.17
17.5
History of dyslipidaemia
0.851
0.821
0.016
0.024
Yes
0.79
±
0.16
30.9
0.78
±
0.16
25.4
No
0.79
±
0.17
30.1
0.74
±
0.18
17.0
Fatty liver disease
0.513
0.635
<
0.001
0.001
Yes
0.79
±
0.17
29.6
0.81
±
0.17
29.7
No
0.80
±
0.16
31.4
0.73
±
0.17
16.0
BMI (kg/m
2
)
0.549
0.017
0.465
0.771
>
30
0.78
±
0.18
16.4
0.78
±
0.14
22.0
≤ 30
0.79
±
0.16
31.8
0.76
±
0.17
20.0
CIMT: carotid intima–media thickness; BMI: body mass index.
Table 4. Univariate and multivariate analysis for risk of subclinical atherosclerosis
Variables
Men (
n
=
630)
Women (
n
=
491)
Univariate analysis
Multivariate analysis
Univariate analysis
Multivariate analysis
HR
CI (95%)
HR
CI (95%)
HR
CI (95%)
HR
CI (95%)
Age
1.10
1.082–1.123
1.11
1.084–1.130
1.09
1.068–1.115
1.08
1.056–1.107
BMI (kg/m
2
)
0.99
0.945–1.043
1.04
0.989–1.096
Waist circumference (cm)
1.01
0.993–1.034
1.04
1.016–1.060
Hypertension
1.88
1.342–2.628
2.88
1.942–4.276
1.82
1.135–2.902
Fatty liver disease
1.05
0.765–1.440
2.09
1.408–3.102
1.65
1.007–2.697
Triglycerides (mg/dl)
1.00
0.997–1.001
1.00
1.000–1.005
HDL-C (mg/dl)
1.00
0.982–1.015
0.99
0.972–1.002
Fasting glucose (mg/dl)
1.02
1.008–1.024
1.01
1.001–1.018
1.01
1.000–1.023
BMI: body mass index; HDL-C: high-density lipoprotein cholesterol; HR: hazard ratio; CI: confidence interval.
Subclinical atherosclerosis is defined as an increased CIMT value (
≥
75th percentile CIMT) or the presence of plaque.