Transient elastography and serum markers of liver fibrosis associate with epicardial adipose tissue and coronary artery calcium in NAFLD

Abstract

Non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease morbimortality. However, it is not clear if NAFLD staging may help identify early or subclinical markers of cardiovascular disease. We aimed to evaluate the association of liver stiffness and serum markers of liver fibrosis with epicardial adipose tissue (EAT) and coronary artery calcium (CAC) in an observational cross-sectional study of 49 NAFLD patients that were seen at Clínica Universidad de Navarra (Spain) between 2009 and 2019. Liver elastography and non-invasive fibrosis markers were used to non-invasively measure fibrosis. EAT and CAC, measured through visual assessment, were determined by computed tomography. Liver stiffness showed a direct association with EAT (r = 0.283, p-value = 0.049) and CAC (r = 0.337, p-value = 0.018). NAFLD fibrosis score was associated with EAT (r = 0.329, p-value = 0.021) and CAC (r = 0.387, p-value = 0.006). The association of liver stiffness with CAC remained significant after adjusting for metabolic syndrome features (including carbohydrate intolerance/diabetes, hypertension, dyslipidaemia, visceral adipose tissue, and obesity). The evaluation of NAFLD severity through liver elastography or non-invasive liver fibrosis biomarkers may contribute to guide risk factor modification to reduce cardiovascular risk in asymptomatic patients. Inversely, subclinical cardiovascular disease assessment, through Visual Scale for CAC scoring, may be a simple and effective measure for patients with potential liver fibrosis, independently of the existence of other cardiovascular risk factors.

Figure 1

LE liver elastography, CT-WBS computed tomography whole body scan, CT-TS computed tomography thoracic scan. *Of the initial cohort of 485 patients, 436 were excluded for one or more of the following criteria that may have affected cardiovascular outcomes or had a different liver disease: personal history of cardiovascular disease (n = 12); active malignancy (n = 52); endocrine diseases (n = 1); excessive alcohol consumption (n = 125); viral hepatitis (n = 123); autoimmune liver disease (n = 28); toxic hepatitis (n = 10); steatogenic drugs (n = 2); iron overload (n = 8); alfa1-antitripsin deficit (n = 6); cirrhosis (n = 7); inflammatory diseases (n = 10); portal hypertension (n = 12) and other liver disease (cholestasis, cystic fibrosis, amyloidosis, Gilbert’s syndrome, paludism, thalassemia) (n = 40).

Figure 2

Correlations of liver stiffness and fibrosis serum markers with epicardial fat and coronary artery calcium levels.