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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018
AFRICA
93
Comparison of carotid intima–media thickness and
coronary artery calcium score for estimating subclinical
atherosclerosis in patients with fatty liver disease
Hyun-Jin Kim, Hyung-Bok Park, Yongsung Suh, Yoon-Hyeong Cho, Eui-Seok Hwang, Deok-Kyu Cho,
Tae-Young Choi
Abstract
Introduction:
Fatty liver disease (FLD) is correlated with
cardiovascular disease. Carotid intima–media thickness
(CIMT) and coronary artery calcium score (CACS) can non-
invasively identify subclinical atherosclerosis and predict risk
for cardiovascular events. This study evaluated CIMT and
CACS measurements to detect subclinical atherosclerosis in
patients with and without FLD.
Methods:
Patients who underwent carotid and abdominal
ultrasounds as well as cardiac computed tomography (CT)
scans were evaluated retrospectively. The differences between
the mean CIMT value and CACS measurements in patients
with FLD and those with normal livers were estimated.
Results:
Among 819 patients (average age of 53.3
±
11.2
years), 330 had FLD. The CIMT was greater in patients with
FLD compared to the controls (0.79
±
0.17 vs 0.76
±
0.17
mm,
p
=
0.012), and carotid plaques were more commonly
seen in patients with FLD. The incidence of a composite of
larger CIMT (
≥
75th percentile) plus plaque presence was
higher in FLD patients (43.3 vs 36.0%,
p
=
0.041). Particularly
among young patients (
≤
50), the CIMT was larger in patients
with FLD than in the controls. FLD increased the risk of
a composite of large CIMT plus plaque presence in young
patients (odds ratio 1.92, 95% confidence interval 1.05–3.49,
p
=
0.034). However, patients with FLD had no greater inci-
dence of CACS of over 100 than the controls.
Conclusion:
CIMT was a better marker of underlying subclini-
cal atherosclerotic risk among patients with FLD than CACS.
FLD particularly, increases the risk of subclinical atheroscle-
rosis in patients younger than 50 years of age. These patients
should undergo screening CIMT to detect atherosclerosis and
modify risk factors.
Keywords:
atherosclerosis, carotid intima–media thickness, coro-
nary artery calcium score, fatty liver
Submitted 3/3/17, accepted 19/11/17
Published online 8/12/17
Cardiovasc J Afr
2017;
29
: 93–98
www.cvja.co.zaDOI: 10.5830/CVJA-2017-052
Fatty liver disease, a common hepatic manifestation of
the metabolic syndrome, is linked to an increased risk for
cardiovascular disease and is proposed to be an independent risk
factor for cardiovascular disease.
1-3
Patients with fatty liver disease
also have increased cardiovascular mortality rates regardless of
other traditional risk factors,
4
and have increased incidence of
subclinical atherosclerosis.
3
Although the biological mechanism
that explains the relationship between fatty liver disease and
atherosclerosis has not been fully proven, recent studies have
shown that it may be related to hepatic insulin resistance, chronic
inflammation, oxidative stress and dyslipidaemia, including low
adiponectin levels.
5-7
Carotid intima–media thickness (CIMT), as measured by
carotid ultrasound, has been used as a surrogate measurement of
subclinical atherosclerosis.
8
This measurement is correlated with
risk for cardiovascular events.
9
Coronary artery calcium score
(CACS), as measured by cardiac computed tomography (CT)
scan, is also a known marker of atherosclerosis, and the clinical
risk for all-cause mortality and cardiovascular disease events
increases with increasing CACS.
10
In addition, CACS over 100 is
a known predictor of coronary events.
11,12
Although previous studies have shown that fatty liver disease
is associated with coronary artery calcification,
13,14
there are
no specific guidelines recommending screening for subclinical
atherosclerosis in patients with fatty liver disease. Further
evaluations should assess the progression of atherosclerosis in
young patients with fatty liver disease, even in the absence of
other traditional risk factors.
This study evaluated the efficacy of CIMT measurements and
CACS in detecting subclinical atherosclerosis in patients with
fatty liver disease.
Methods
This was a retrospective cohort study and the sample was
made up of patients who visited our healthcare centre to
undergo routine healthcare maintenance evaluations between
June 2011 and December 2013 (
n
=
23 474). Inclusion criteria
were performance on the same day of carotid and abdominal
ultrasounds as well as cardiac CT scans evaluating for coronary
calcifications (
n
=
1 064). Patients were excluded from the study
if they had conditions that could lead to chronic liver disease,
including hepatitis B surface antigen positivity (
n
=
60), hepatitis
C antibody positivity (
n
=
6), or excessive alcohol consumption
(
≥
20 g/day)
15
(
n
=
179).
Department of Cardiology, Myongji Hospital, Goyang-si,
South Korea
Hyun-Jin Kim, MD
Hyung-Bok Park, MD
Yongsung Suh, MD
Yoon-Hyeong Cho, MD
Eui-Seok Hwang, MD
Deok-Kyu Cho, MD
Department of Internal Medicine, Cardiovascular Centre,
Myongji Hospital, Goyang-si, South Korea
Tae-Young Choi, MD,
tchoicardio@gmail.com