Non-alcoholic fatty liver disease and progression of coronary artery calcium score: a retrospective cohort study.
Non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome, was associated with subclinical atherosclerosis in many cross-sectional studies, but the prospective association between NAFLD and the progression of atherosclerosis has not been evaluated. This study was conducted to evaluate the association between NAFLD and the progression of coronary atherosclerosis.



This retrospective cohort study included 4731 adult men and women with no history of cardiovascular disease (CVD), liver disease or cancer at baseline who participated in a repeated regular health screening examination between 2004 and 2013. Fatty liver was diagnosed by ultrasound based on standard criteria, including parenchymal brightness, liver-to-kidney contrast, deep beam attenuation and bright vessel walls. Progression of coronary artery calcium (CAC) scores was measured using multidetector CT scanners.



The average duration of follow-up was 3.9 years. During follow-up, the annual rate of CAC progression in participants with and without NAFLD were 22% (95% CI 20% to 23%) and 17% (16% to 18%), respectively (p<0.001). The multivariable ratio of progression rates comparing participants with NAFLD with those without NAFLD was 1.04 (1.02 to 1.05; p<0.001). The association between NAFLD and CAC progression was similar in most subgroups analysed, including in participants with CAC 0 and in those with CAC >0 at baseline.



In this large cohort study of adult men and women with no history of CVD, NAFLD was significantly associated with the development of CAC independent of cardiovascular and metabolic risk factors. NAFLD may play a pathophysiological role in atherosclerosis development and may be useful to identify subjects with a higher risk of subclinical disease progression.
Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
Dong Hyun
DH
Sinn
Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.
Danbee
D
Kang
Center for Cohort Studies, Total Healthcare Screening Center, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, South Korea.|Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, South Korea.|Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
Yoosoo
Y
Chang
Center for Cohort Studies, Total Healthcare Screening Center, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, South Korea.|Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, South Korea.|Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
Seungho
S
Ryu
Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
Seonhye
S
Gu
Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
Hyunkyoung
H
Kim
Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.
Donghyeong
D
Seong
Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
Soo Jin
SJ
Cho
Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.|Department of Medical Informatics, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
Byoung-Kee
BK
Yi
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
Hyung-Doo
HD
Park
Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
Seung Woon
SW
Paik
Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.|Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, USA.
Young Bin
YB
Song
Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, USA.
Mariana
M
Lazo
Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, USA.
Joao A C
JA
Lima
Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, USA.
Eliseo
E
Guallar
Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.|Center for Cohort Studies, Total Healthcare Screening Center, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, South Korea.|Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.|Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, USA.
Juhee
J
Cho
Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
Geum-Youn
GY
Gwak
D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging*; D002118:Calcium; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014463:Ultrasonography
D002118:Calcium
CARDIOVASCULAR DISEASE; FATTY LIVER; FIBROSIS; ULTRASONOGRAPHY