The relationship between nonalcoholic fatty liver disease and the severity of coronary artery disease in patients with metabolic syndrome.
OBJECTIVE
Nonalcoholic fatty liver disease (NAFLD) is an important complication of metabolic syndrome (MS). We investigated the possible relationship between NAFLD and angiographical severity of coronary artery disease (CAD) in patients with MS.


METHODS
This prospective study included 80 patients (35 men, 45 women; mean age 63+/-10 years; range 42 to 80 years) with a diagnosis of MS according to the ATP III criteria. All patients underwent abdominal ultrasonography to detect NAFLD. Coronary angiography was performed for stable angina pectoris (n=48), unstable angina pectoris (n=21), and prognostic reasons (n=11). The severity of CAD was assessed by the number of vessels involved (vessel score) and the severity score (Gensini score). Significant stenosis was defined as 70% or greater reduction in lumenal diameter.


RESULTS
Ultrasonography revealed NAFLD in 43 patients (53.8%). Patients with NAFLD had significantly higher body mass index, waist circumference, and serum triglyceride level, and significantly lower HDL-cholesterol level (p<0.001). Coronary angiography showed significantly higher vessel (2.5+/-0.9 vs 1.0+/-1.0) and CAD severity scores (90.2+/-40.0 vs 36.4+/-28.9) in patients with NAFLD (p<0.001). Univariate analysis showed that the presence of NAFLD (r=0.61, p<0.001), grade of NAFLD (r=0.42, p<0.001), and patient age (r=0.36, p=0.002) were significantly correlated with the CAD severity score. In multivariate linear regression analysis, the presence of NAFLD was the only independent factor affecting the CAD severity score (beta: 1.35, p<0.001).


CONCLUSIONS
The presence of NAFLD is associated with more severe CAD, requiring that patients with MS be investigated for the presence of NAFLD and those with NAFLD be attentively followed-up for the presence and severity of CAD.
Alper
Ahmet Taha
AT
Department of Cardiology, Siyami Ersek Cardiovascular Surgery Center, Istanbul, Turkey. draalper@hotmail.com
Hasdemir
Hakan
H
Sahin
Sinan
S
Ontürk
Ebru
E
Akyol
Ahmet
A
Nurkalem
Zekeriya
Z
Cakmak
Nazmiye
N
Erdinler
Izzet
I
Gürkan
Kadir
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000097:blood / Q000209:etiology / Q000473:pathology; D000789:Angina, Unstable / Q000097:blood / Q000209:etiology / Q000473:pathology; D008076:Cholesterol, HDL / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000209:etiology / Q000473:pathology*; D005234:Fatty Liver / Q000097:blood / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications* / Q000473:pathology; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014280:Triglycerides / Q000097:blood; D014463:Ultrasonography
D008076:Cholesterol, HDL; D014280:Triglycerides