title: Heart valve calcification in patients with type 2 diabetes and nonalcoholic fatty liver disease.
abstract: OBJECTIVE
  Aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are two powerful predictors of adverse cardiovascular outcomes in patients with type 2 diabetes, but the etiology of valvular calcification is uncertain. Nonalcoholic fatty liver disease (NAFLD) is an emerging cardiovascular risk factor and is very common in type 2 diabetes, but whether NAFLD is associated with valvular calcification in this group of patients is presently unknown.
  
  
  METHODS
  We undertook a cross-sectional study of 247 consecutive type 2 diabetic outpatients with no previous history of heart failure, valvular heart diseases (aortic stenosis, mitral stenosis, moderate or severe aortic and mitral regurgitation) or hepatic diseases. Presence of MAC and AVS was detected by echocardiography. NAFLD was diagnosed by ultrasonography.
  
  
  RESULTS
  Overall, 139 (56.3%) patients had no heart valve calcification (HVC-0), 65 (26.3%) patients had one valve affected (HVC-1) and 43 (17.4%) patients had both valves affected (HVC-2). 175 (70.8%) patients had NAFLD and the prevalence of this disease markedly increased in patients with HVC-2 compared with either HVC-1 or HVC-0 (86.1% vs. 83.1% vs. 60.4%, respectively; p < 0.001). NAFLD was significantly associated with AVS and/or MAC (unadjusted-odds ratio 3.51, 95% CI 1.89-6.51, p < 0.001). Adjustments for age, sex, waist circumference, smoking, blood pressure, hemoglobin A1c, LDL-cholesterol, kidney function parameters, medication use and echocardiographic variables did not appreciably weaken this association (adjusted-odds ratio 2.70, 95% CI 1.23-7.38, p < 0.01).
  
  
  CONCLUSIONS
  Our results show that NAFLD is an independent predictor of cardiac calcification in both the aortic and mitral valves in patients with type 2 diabetes.
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mantovani
authors.affiliation: Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Pernigo
authors.affiliation: Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Corinna
authors.initials: C
authors.lastname: Bergamini
authors.affiliation: Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR) Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonapace
authors.affiliation: Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR) Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Lipari
authors.affiliation: Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR) Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Valbusa
authors.affiliation: Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR) Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bertolini
authors.affiliation: Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR) Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Zenari
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Pichiri
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Dauriz
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zoppini
authors.affiliation: Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR) Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Barbieri
authors.affiliation: Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Byrne
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Bonora
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy. Electronic address: giovanni.targher@univr.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Targher
mesh_terms: D000368:Aged; D001021:Aortic Valve; D002114:Calcinosis / Q000209:etiology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006349:Heart Valve Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D012598:Sclerosis / Q000473:pathology
keywords: Aortic valve sclerosis; Heart valve calcification; Mitral annulus calcification; Nonalcoholic fatty liver disease; Type 2 diabetes