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Observational Study
. 2013 Aug 6;10(8):3409-23.
doi: 10.3390/ijerph10083409.

Relationship between retinal vascular caliber and coronary artery disease in patients with non-alcoholic fatty liver disease (NAFLD)

Pikkel Josef  1 , Ibrahim Ali, Prober Ariel, Marmor Alon, Assy Nimer
Affiliations
Observational Study

Relationship between retinal vascular caliber and coronary artery disease in patients with non-alcoholic fatty liver disease (NAFLD)

Pikkel Josef et al. Int J Environ Res Public Health. .

Abstract

Objective: To evaluate the relationship between retinal vascular caliber and cardiovascular disease in non-alcoholic fatty liver disease (NAFLD) patients without diabetes and hypertension.

Methods: Intention to treat study of individuals who underwent cardiac computed tomography (CT) during a two year period. Coronary artery disease (CAD) was defined as stenosis of >50% in at least one major coronary artery. Liver and spleen density were measured by abdominal (CT); intima-media thickness (IMT) by Doppler ultrasound; retinal artery and vein diameter by colored-retinal angiography; and metabolic syndrome by ATP III guidelines. Serum biomarkers of insulin resistance, inflammation, and oxidant-antioxidant status were assessed.

Results: Compared with 22 gender and age matched controls, the 29 NAFLD patients showed higher prevalence of coronary plaques (70% vs. 30%, p < 0.001), higher prevalence of coronary stenosis (30% vs. 15%, p < 0.001), lower retinal arteriole-to-venule ratio (AVR) (0.66 ± 0.06 vs. 0.71 ± 0.02, p < 0.01), higher IMT (0.98 ± 0.3 vs. 0.83 ± 0.1, p < 0.04), higher carotid plaques (60% vs. 40%, p < 0.001), higher homeostasis model assessment of insulin resistance (HOMA) (4.0 ± 3.4 vs. 2.0 ± 1.0, p < 0.005), and higher triglyceride levels (200 ± 80 vs. 150 ± 60, p < 0.005) than controls. Multivariate analysis showed fatty liver (OR 2.5; p < 0.01), IMT (OR 2.3 p < 0.001), and retinal AVR ratio (OR 1.5, p < 0.01) to be strongly associated with CAD independent of metabolic syndrome (OR 1.2, p < 0.05).

Conclusions: Patients with smaller retinal AVR (<0.7) are likely to be at increased risk for CAD and carotid atherosclerosis in patients with NAFLD even without hypertension or diabetes.

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Figures

Figure 1
Figure 1
Example of fatty liver diagnosed by CT: liver minus spleen density > −10 Hounsfield units (HU).
Figure 2
Figure 2
Digitized retinal photographs showing examples of low and high arteriole-to-venule ratio (AVR). (A), AVR = 0.789; (B), AVR = 0.973. Arterioles are lighter in intensity compared with venules. (Two different patients).
Figure 3
Figure 3
Cardiac CT: Example of soft (non calcified) coronary plaques at the proximal area of the right coronary artery (arrow).
Figure 4
Figure 4
Example of abnormal intima media thickening (IMT). Normal values of IMT: (age > 50 years; women < 0.7 mm, men < 0.8 mm).
See this image and copyright information in PMC

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