Resarch ArticleFatty liver is an independent predictor of early carotid atherosclerosis

Background & AimsWhether steatosis is incidentally or causally associated with carotid atherosclerosis is debated, and long-term follow-up data are missing. This study aims to examine the impact of steatosis on the presence and progression of carotid intima-media thickness (C-IMT) and carotid plaques (CP) in a large cohort with longitudinal follow-up.MethodsA retrospective single-center study between 1995 and 2012. Transversal cohort: patients with ⩾2 cardiovascular risk factors without previous cardiovascular events. Longitudinal cohort: patients with two consecutive C-IMT measurements more than 2 years apart. Steatosis was defined by a surrogate marker, the fatty liver index (FLI). CP and C-IMT were assessed by carotid ultrasound.ResultsIn the transversal cohort (n = 5671) both C-IMT and the Framingham risk score (FRS) increased across FLI quartiles (0.58 ± 0.12, 0.61 ± 0.14, 0.63 ± 0.14, 0.64 ± 0.14 mm, and 5 ± 5%, 9 ± 7%, 12 ± 8%, 15 ± 9%, p <0.001 for both). Steatosis predicted C-IMT better than diabetes or dyslipidemia. Steatosis independently predicted C-IMT (p = 0.002) and FRS (p <0.001) after adjustment for metabolic syndrome and cardiovascular risk factors.In the longitudinal cohort (n = 1872, mean follow-up 8 ± 4 years), steatosis occurred in 12% and CP in 23% of patients. C-IMT increased in patients with steatosis occurrence (from 0.60 ± 0.13 mm to 0.66 ± 0.14 mm, p = 0.001) whereas it did not change in those that stayed free of steatosis. Steatosis at baseline predicted CP occurrence (OR = 1.63, 95% CI 1.10-2.41, p = 0.014), independent of age, sex, type-2 diabetes, tobacco use, hsCRP, hypertension and C-IMT.ConclusionsIn patients with metabolic syndrome at risk for cardiovascular events, steatosis contributes to early atherosclerosis and progression thereof, independent of traditional cardiovascular risk factors.

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