title: Progression of carotid vascular damage and cardiovascular events in non-alcoholic fatty liver disease patients compared to the general population during 10 years of follow-up.
abstract: OBJECTIVE
  Non-alcoholic fatty liver disease (NAFLD) is associated not only with liver related morbidity and mortality but also with an increased risk of cardiovascular disease.
  
  
  OBJECTIVE
  to evaluate in patients with NAFLD and in matched Controls after 10 years of follow-up 1 the incidence of major cardiovascular and cerebral events 2 the progression of vascular damage.
  
  
  METHODS
  Clinical and cardio-metabolic data were collected in 125 NAFLD patients and 250 age and gender matched Controls at baseline and 10 years later. Incidence of cardiovascular and cerebral events was recorded. By ultrasonography, carotid intima-media thickness (cIMT), presence of plaques and presence of fatty liver were evaluated.
  
  
  RESULTS
  25% of the overall series was lost to follow-up. Sixty-eight (37%) Controls developed steatosis. Major cardiovascular events were observed in thirty-five subjects (17/91 (19%) NAFLD and 18/182 (10%) Controls), with an estimated cumulative risk significantly higher in NAFLD than in Controls, log-rank test for equality of failure functions p = 0.007. At multivariate analysis, presence of plaques (hazard ratio 5.08 (95% C.I. 2.56-10.96) and of steatosis (hazard ratio 1.99 (1.01-3.94)) were the strongest predictors for cardiovascular events. Grade of steatosis, ALT and GGT levels were higher in NAFLD patients who developed cardiovascular events. cIMT value after 10 years was significantly higher in NAFLD than in Controls, but the mean progression rate was higher in Controls (0.015 and 0.006 mm/year, p = 0.001). In conclusion our results suggest that NAFLD has to be included among risk factors for cardiovascular damage and underline the utility to evaluate, once NAFLD is diagnosed, the presence of atherosclerotic lesions.
authors.affiliation: Department of Pathophysiology and Transplantation, Ca' Granda Foundation IRCCS Maggiore Policlinico Hospital, University of Milan, Milan, Italy. Electronic address: anna.fracanzani@unimi.it.
authors.forename: Anna Ludovica
authors.initials: AL
authors.lastname: Fracanzani
authors.affiliation: Department of Pathophysiology and Transplantation, Ca' Granda Foundation IRCCS Maggiore Policlinico Hospital, University of Milan, Milan, Italy. Electronic address: silvia.tiraboschi@studenti.unimi.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Tiraboschi
authors.affiliation: Department of Pathophysiology and Transplantation, Ca' Granda Foundation IRCCS Maggiore Policlinico Hospital, University of Milan, Milan, Italy. Electronic address: pinaz81@hotmail.com.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Pisano
authors.affiliation: Epidemiology Unit, Ca' Granda Foundation IRCCS Maggiore Policlinico Hospital, University of Milan, Milan, Italy. Electronic address: dario.consonni@unimi.it.
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.affiliation: Department of Pharmacological and Biomolecular Sciences, University of Milan and Centro Studi Aterosclerosi, Milan Italy. Electronic address: andrea.baragetti@guest.unimi.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Baragetti
authors.affiliation: Department of Pathophysiology and Transplantation, Ca' Granda Foundation IRCCS Maggiore Policlinico Hospital, University of Milan, Milan, Italy. Electronic address: cristinagiuliabertelli@yahoo.it.
authors.forename: Cristina
authors.initials: C
authors.lastname: Bertelli
authors.affiliation: Department of Pharmacological and Biomolecular Sciences, University of Milan and Centro Studi Aterosclerosi, Milan Italy. Electronic address: danilo.norata@unimi.it.
authors.forename: Danilo
authors.initials: D
authors.lastname: Norata
authors.affiliation: Department of Pathophysiology and Transplantation, Ca' Granda Foundation IRCCS Maggiore Policlinico Hospital, University of Milan, Milan, Italy. Electronic address: luca.valenti@unimi.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Valenti
authors.affiliation: Centro Studi Aterosclerosi, Bassini Hospital Milan, Italy. Electronic address: centroaterocat@gmail.com.
authors.forename: Liliana
authors.initials: L
authors.lastname: Grigore
authors.affiliation: Department of Pathophysiology and Transplantation, Ca' Granda Foundation IRCCS Maggiore Policlinico Hospital, University of Milan, Milan, Italy. Electronic address: marianna.porzio@unimi.it.
authors.forename: Marianna
authors.initials: M
authors.lastname: Porzio
authors.affiliation: Department of Pharmacological and Biomolecular Sciences, University of Milano, and Multimedica IRCCS Milan, Italy. Electronic address: alberico.catapano@unimi.it.
authors.forename: Alberico
authors.initials: A
authors.lastname: Catapano
authors.affiliation: Department of Pathophysiology and Transplantation, Ca' Granda Foundation IRCCS Maggiore Policlinico Hospital, University of Milan, Milan, Italy. Electronic address: silvia.fargion@unimi.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Fargion
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Cardiovascular events; Carotid plaques; Intima-media thickness; NAFLD; NASH