title: Nonalcoholic fatty liver disease is associated with coronary artery calcification.
abstract: Nonalcoholic fatty liver disease (NAFLD) is related to risk factors of coronary artery disease, such as dyslipidemia, diabetes, and metabolic syndrome, which are closely linked with visceral adiposity. The aim of this study was to investigate whether NAFLD was associated with coronary artery calcification (CAC), which is used as a surrogate marker for coronary atherosclerosis independent of computed tomography (CT)-measured visceral adiposity. Out of 5,648 subjects who visited one of our health screening centers between 2003 and 2008, we enrolled 4,023 subjects (mean age, 56.9 ± 9.4 years; 60.7% males) without known liver disease or a history of ischemic heart disease. CAC score was evaluated using the Agatston method. On univariate analysis, the presence of CAC (score >0) was significantly associated with age, sex, body mass index, aspartate aminotransferase, alanine aminotransferase, high-density lipoprotein cholesterol, triglycerides, and increased risk of diabetes, hypertension, smoking, and NAFLD. Increasing CAC scores (0, <10, 10-100, ≥ 100) were associated with higher prevalence of NAFLD (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.61-2.10; P<0.001). Multivariable ordinal regression analysis was adjusted for traditional risk factors, and CT-measured visceral adipose tissue area in a subgroup of subjects showed that the increased CAC scores were significantly associated with the presence of NAFLD (OR, 1.28, 95% CI, 1.04-1.59; P = 0.023) independent of visceral adiposity.
  
  
  CONCLUSIONS
  Patients with NAFLD are at increased risk for coronary atherosclerosis independent of classical coronary risk factors, including visceral adiposity. These data suggest that NAFLD might be an independent risk factor for coronary artery disease.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea. messmd@chol.com
authors.forename: Donghee
authors.initials: D
authors.lastname: Kim
authors.forename: Su-Yeon
authors.initials: SY
authors.lastname: Choi
authors.forename: Eun Ha
authors.initials: EH
authors.lastname: Park
authors.forename: Whal
authors.initials: W
authors.lastname: Lee
authors.forename: Jin Hwa
authors.initials: JH
authors.lastname: Kang
authors.forename: Won
authors.initials: W
authors.lastname: Kim
authors.forename: Yoon Jun
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Yoon
authors.forename: Sook Hyang
authors.initials: SH
authors.lastname: Jeong
authors.forename: Dong Ho
authors.initials: DH
authors.lastname: Lee
authors.forename: Hyo-suk
authors.initials: HS
authors.lastname: Lee
authors.forename: Joseph
authors.initials: J
authors.lastname: Larson
authors.forename: Terry M
authors.initials: TM
authors.lastname: Therneau
authors.forename: W Ray
authors.initials: WR
authors.lastname: Kim
mesh_terms: D017677:Age Distribution; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease; D015995:Prevalence; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D014463:Ultrasonography