Fatty liver, insulin resistance and obesity: relationships with increase in coronary artery calcium over time

Abstract

Background: Non alcoholic fatty liver disease (NAFLD), insulin resistance (IR) and obesity frequently co-exist with type 2 diabetes but it is uncertain whether these risk factors for vascular disease contribute to a change in at herosclerosis over time, independently of diabetes status. We tested whether the combination of fatty liver, IR and obesity was associated with an increase in coronary artery calcium (CAC) score over time, independently of diabetes status, other cardiovascular risk factors and medications.

Methods: Data were analysed from a South Korean occupational cohort of 2175 people. The outcome was increase in cardiac computed tomography (CT) CAC score between baseline and follow up. IR was defined by HOMA-IR?75th centile and fatty liver by ultrasound. Hazard ratios (HR) [95% confidence intervals (CIs)] were estimated using Cox proportional hazards regression.

Results: There were 592 (27.2%) participants in whom CAC score increased from baseline (mean±SD age at baseline 44.8±5.5 years) and 1583 subjects in whom CAC did not change or improved during follow up (mean±SD age 41.6± 5.6 years). Diabetes, HOMA-IR, fatty liver and obesity prevalence were all higher (all p<0.001), in participants in whom CAC score increased from baseline. Adjusting for diabetes and potential confounders, the combination of IR, obesity and fatty liver was independently associated with increase in CAC score over time [(HR 2.46, (95%CIs 1.50,4.03)].

Conclusions: The combination of fatty liver, IR and obesity is associated with progression of atherosclerosis over time independently of diabetes, cardiovascular risk factors, and all medications for cardiovascular disease and diabetes

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ORCID for CD Byrne: orcid.org/0000-0001-6322-7753

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