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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018
AFRICA
95
patients with a CACS under 100, the mean CIMT value was also
significantly higher among patients with fatty liver disease (
n
=
298) compared to those with normal livers (
n
=
448) (0.78
±
0.17
vs 0.75
±
0.17 mm,
p
=
0.013).
Discussion
The clinical characteristics of patients with fatty liver disease
were worse than those of patients with normal livers in our
study. The carotid ultrasound images reflected these findings
that an increased mean CIMT value was associated with fatty
liver disease, and that a composite incidence of larger CIMT
(
≥
75th percentile) plus the presence of carotid plaque was also
associated with fatty liver disease. Interestingly, young patients
(less than 50 years of age) with fatty liver disease showed an
increased risk of subclinical atherosclerosis proven by carotid
ultrasound rather than by CACS. CIMT was a sensitive marker
in identifying atherosclerosis in patients with fatty liver disease,
even with a CACS of zero or less than 100.
The pathogenesis of fatty liver disease has been not fully
elucidated, but insulin resistance and subclinical inflammation
are known to be key mechanisms in the development of fatty
Table 1. Baseline patient characteristics
All (
n
=
819)
Fatty liver disease (
n
=
330)
Normal livers (
n
=
489)
p
-value
Age (years)
53.25
±
11.20
53.44
±
10.87
53.13
±
11.42
0.698
Male,
n
(%)
415 (50.7)
212 (64.2)
206 (41.5)
< 0.001
Waist circumference (cm)
81.66
±
9.39
87.07
±
7.88
77.99
±
8.53
< 0.001
Hip circumference (cm)
94.56
±
6.14
97.02
±
6.02
92.89
±
5.65
< 0.001
Waist-to-hip ratio
0.86
±
0.07
0.90
±
0.06
0.84
±
0.07
< 0.001
BMI (kg/m
2
)
25.07
±
3.41
26.88
±
3.19
23.85
±
2.98
< 0.001
SBP (mmHg)
121.95
±
13.11
125.9
±
12.38
119.25
±
12.91
< 0.001
DBP (mmHg)
74.67
±
9.80
77.95
±
9.12
72.46
±
9.63
< 0.001
Previous history
Hypertension,
n
(%)
263 (32.1)
141 (42.17)
122 (24.9)
< 0.001
Diabetes,
n
(%)
108 (13.2)
70 (21.2)
38 (7.8)
< 0.001
Dyslipidaemia,
n
(%)
263 (32.1)
141 (42.7)
122 (24.9)
< 0.001
Fasting blood glucose (mg/dl)
99.54
±
18.95
105.04
±
20.85
95.82
±
16.57
< 0.001
(mmol/l)
(5.52
±
1.05)
(5.83
±
1.16)
(5.32
±
0.92)
HbA
1c
(%)
5.75
±
0.68
5.96
±
0.78
5.62
±
0.57
< 0.001
Homocysteine (μmol/l)
10.5 (8.9–12.4)
11.1 (9.3–13.2)
10.2 (8.7–12.0)
< 0.001
Total cholesterol (mg/dl)
191.0 (170.0–214.0)
194.0 (174.0–218.0)
186.0 (167.0–211.5)
0.001
(mmol/l)
[4.95 (4.40–5.54)]
[5.02 (4.51–5.65)]
[4.82 (4.33–5.48)]
Triglycerides (mg/dl)
115.0 (77.0–17.01)
146.0 (102.8–212.8)
95.0 (59.0–143.0)
< 0.001
(mmol/l)
[1.30 (0.87–0.19)]
[1.65 (1.16–2.40)]
[1.07 (0.67–1.62)]
LDL cholesterol (mg/dl)
112.0 (93.0–131.0)
116.5 (98.0–134.0)
107.0 (91.0–129.0)
0.001
(mmol/l)
[2.90 (2.41–3.39)]
[3.02 (2.54–3.47)]
[2.77 (2.36–3.34)]
AST (IU/l)
23.0 (19.0–27.0)
25.0 (20.0–31.0)
21.0 (18.0–26.0)
< 0.001
ALT (IU/l)
20.0 (14.0–29.0)
27.0 (19.0–40.3)
17.0 (13.0–23.0)
< 0.001
Gamma-GTP (IU/l)
25.5 (17.0–42.0)
35.5 (24.0–59.0)
21.0 (15.0–31.0)
< 0.001
ALP (IU/l)
83.0 (53.0–193.0)
85.0 (56.8–201.3)
79.0 (52.0–182.0)
0.023
BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; HbA
1c
: haemoglobin A
1c
; LDL cholesterol: low-density lipoprotein cholesterol;
AST: aspartate aminotransferase; ALT: alanine aminotransferase; Gamma-GTP: gamma-glutamyl transpeptidase; ALP: alkaline phosphatase.
Table 2. Difference in CIMT and CACS between the two groups
All (
n
=
819)
Fatty liver disease (
n
=
330) Normal liver (
n
=
489)
p-
value
CIMT (mm)
0.77
±
0.17
0.79
±
0.17
0.76
±
0.17
0.012
Presence of plaque,
n
(%)
195 (23.8)
89 (27.0)
106 (21.7)
0.094
CIMT
≥
75th percentile or presence of plaque,
n
(%)
319 (38.9)
143 (43.3)
176 (36.0)
0.041
Cardiac CT calcium score
53.07
±
250.14
73.85
±
323.29
39.05
±
184.20
0.077
Cardiac CT calcium score
>
100,
n
(%)
73 (8.9)
32 (9.7)
41 (8.4)
0.518
CIMT: carotid intima–media thickness; CACS: coronary artery calcium score.
Table 3. CIMT, carotid plaque and CACS according to age group
Age group, years (
n
)
Fatty liver disease
Normal liver
p-
value
CIMT (mm) (
n
)
< 30 (20)
0.66
±
0.11 (4)
0.54
±
0.11 (16)
0.056
31–40 (98)
0.70
±
0.15 (43)
0.63
±
0.14 (55)
0.022
41–50 (192)
0.76
±
0.17 (73)
0.69
±
0.16 (119)
0.006
51–60 (295)
0.80
±
0.16 (123)
0.80
±
0.15 (172)
0.951
61–70 (158)
0.85
±
0.15 (65)
0.85
±
0.14 (93)
0.936
>
70 (56)
0.89
±
0.14 (22)
0.87
±
0.16 (34)
0.661
CACS
< 30
0
0
–
31–40
1.21
±
4.06
2.25
±
14.62
0.650
41–50
16.62
±
73.57
18.37
±
133.82
0.918
51–60
82.89
±
412.46
28.67
±
117.79
0.158
61–70
93.32
±
300.54
94.85
±
337.18
0.977
>
70
311.00
±
521.03
89.18
±
197.92
0.028
Carotid plaque,
n
(%)
< 30
0
0
–
31–40
3 (7.0)
4 (7.3)
1.000
41–50
10 (13.7)
9 (7.6)
0.167
51–60
32 (26.0)
36 (20.9)
0.306
61–70
32 (49.2)
40 (43.0)
0.440
>
70
12 (54.4)
17 (50.0)
0.740