Endocrine Abstracts

Patients with non-alcoholic fatty liver disease (NAFLD) have a higher prevalence of cardiovascular disease, particularly patients with liver fibrosis. Studies have shown a relationship between epicardial fat/coronary calcium and myocardial ischemia.

Aim: Quantify epicardial fat and coronary calcium assessed by computed tomography (CT) in patients with NAFLD. Additionally, determine whether patients with hepatic fibrosis quantitatively assessed by liver elastography (LE), Fibrosis-4 (FIB-4) Score and NAFLD Fibrosis Score correlate with an increased risk of cardiovascular disease by assessing epicardial fat and coronary calcium volume quantified by CT.

Methods: A retrospective and cross-sectional study was conducted in 81 patients with NAFLD. Patients with other causes of liver disease were excluded. Clinical data, serum markers and imaging studies (CT and LE) were obtained. In LE, the presence of increased liver stiffness was determined if ≥8.2 kPa. On CT, epicardial fat and visceral fat were quantified between –45 to –190 voxels and coronary calcium according to the Agatston method.

Results: The average age was 58.98 ± 10.63 years. 82.72% (67/81) were men, with an average BMI of 30.22 ± 4.83 kg/m² and body fat (CUN-BAE) of 33.96 ± 7.56%. A 43.21% (35/81) had hypertension, 53.08% (43/81) dyslipidemia, 17.28% (14/81) OSAS, 17.28% (14/81) hyperuricemia, 35.80% (29/81) had type 2 diabetes, 30.86% (25/81) had prediabetes and 64.19% (52/81) were current or former smokers. A moderate-severe insulin resistance (HOMA-IR of 6.43 ± 2.74) was found. Patients with diabetes had 7.44 ± 7.07 years of evolution with a mean HbA1c of 7.19 ± 0.91%. A 13.58% (11/81) presented increased liver stiffness assessed by LE. On average, the patients presented a liver stiffness (LE) of 6.24 ± 2.94 kPa, coronary calcium of 291.97 ± 484.98 and epicardial fat of 201.98 ± 107.85 cm³. There was a significant positive correlation between liver stiffness (LE) and epicardial fat (r = 0.274; P = 0.027), as well as with coronary calcium (r = 0.66; P = 0.005). Additionally, a positive correlation was found between epicardial and visceral fat (r = 0.731; P ≤ 0.001). Patients with liver stiffness (LE) had a significantly higher epicardial fat volume (283.74 ± 130.11 vs 166.14 ± 81.26 cm³; P = 0.014) and a non-significant higher coronary calcium score (325.13 ± 417.96 vs 124.78 ± 179.93; P = 0.188). No significant correlation was found between FIB-4 Score or NAFLD Fibrosis Score and epicardial fat volume or coronary calcium.

Conclusions: Hepatic fibrosis assessed by LE and visceral fat assessed by CT is positively correlated with epicardial fat and coronary calcium. The early identification of these situations may alert clinicians to establish preventive measures in order to reduce the cardiovascular risk of these patients.