Advanced fibrosis associates with atherosclerosis in subjects with nonalcoholic fatty liver disease

•We explored the association between advanced fibrosis and subclinical atherosclerosis in NAFLD patients.•Advanced fibrosis was positively associated with subclinical atherosclerosis parameters in the NAFLD patients.•The positive association was independent of conventional cardiometabolic risk factors and insulin resistance.•NFS might be useful to assess future CVD risk of NAFLD patients.•Early prevention of CVD should be valued in NAFLD patients with NFS > 0.676.

ObjectiveNonalcoholic fatty liver (NAFLD) with advanced fibrosis usually has a deteriorated prognosis, which was mainly attributed to cardiovascular cause. We investigated whether advanced fibrosis assessed by noninvasive fibrosis markers was associated with subclinical atherosclerosis in NAFLD patients.MethodsA total of 2550 participants with ultrasound confirmed NAFLD from a community based population study were included in the present analysis. NAFLD fibrosis score (NFS) derived from available parameters was calculated to assess severity of fibrosis of the NAFLD patients. The NAFLD patients with a NFS > 0.676 indicated of presence of advanced fibrosis. The carotid intima-media thickness (CIMT), carotid plaques and brachial-ankle pulse wave velocity (ba-PWV) were used as the indicators of early atherosclerosis.ResultsNAFLD patients with advanced fibrosis had higher CIMT and ba-PWV, compared with those without fibrosis (CIMT: 0.65 versus 0.57 mm; ba-PWV: 1884 versus 1535 cm/s, both p < 0.0001). Participants with advanced fibrosis were more likely to have higher homeostasis model assessment of insulin resistance index (HOMA_IR, 3.28 versus 2.45, p < 0.0001). After adjusting the confounders, participants with advanced fibrosis associated with 1.98-folds increased risk for elevated CIMT, 2.28-folds increased risk for present carotid plaque and 2.68-folds increased risk for arterial stiffness, respectively, as compared to participants without fibrosis. After further adjustment for HOMA_IR, the positive associations did not appreciably change.ConclusionAdvanced fibrosis indicated by NFS was positively associated with CIMT, presence of carotid plaque and arterial stiffness in the NAFLD patients, independent of conventional cardiometabolic risk factors and insulin resistance.