title: Nonalcoholic fatty liver disease is associated with coronary artery calcification: A systematic review and meta-analysis.
abstract: BACKGROUND
  Nonalcoholic fatty liver disease (NAFLD) is associated increased cardiovascular events and mortality. Coronary artery calcium scanning (CAC) is the robust predictor of coronary events in the asymptomatic individuals. Several recent studies have investigated the association between NAFLD and this surrogate marker. Thus, we conducted a systematic review and meta-analysis to better characterize the association between NAFLD and CAC.
  
  
  METHODS
  MEDLINE and EMBASE were searched through May 2016. Primary outcome was the association between NAFLD and CAC. Pooled odds ratio (OR) and 95% confidence interval (CI) from multivariable-adjusted estimates were calculated using a random-effects model. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2.
  
  
  RESULTS
  Data were extracted from 16 studies (all cross-sectional studies) involving 16,433 NAFLD patients and 41,717 controls. NAFLD is significantly associated with CAC score >0 and CAC score >100 with pooled OR of 1.41 (95%CI 1.26-1.57, Pheterogeneity=0.07, I2=66%) and 1.24 (95%CI 1.02-1.52, Pheterogeneity=0.10, I2=42%).
  
  
  CONCLUSIONS
  NAFLD is associated with increased coronary artery calcification independent of traditional risk factors. The assessment of coronary artery calcium may be useful in identifying NAFLD patients at risk of future cardiovascular events.
authors.affiliation: Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA; Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Electronic address: veeravich_j@hotmail.com.
authors.forename: Veeravich
authors.initials: V
authors.lastname: Jaruvongvanich
authors.affiliation: Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA. Electronic address: kamonac120@gmail.com.
authors.forename: Kamonkiat
authors.initials: K
authors.lastname: Wirunsawanya
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA; Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: anawin.sanguankeo@bassett.org.
authors.forename: Anawin
authors.initials: A
authors.lastname: Sanguankeo
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA; Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: sikarin.upala@bassett.org.
authors.forename: Sikarin
authors.initials: S
authors.lastname: Upala
mesh_terms: D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000175:diagnosis; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: Coronary artery disease; Coronary calcification; Coronary calcium; Meta-analysis; Nonalcoholic fatty liver disease