Endocrine Abstracts

Introduction: Over the last few years, there are some studies that suggests a close connection between Nonalcoholic Liver Disease (NAFLD) and increased cardiovascular (CV) risk in population with obesity. Indeed, these two conditions share common drivers, most notably insulin resistance and other elements of the metabolic syndrome. Notwithstanding the above, this affirmation does not have solid scientific evidence. The proliferation of Vasa Vasorum (VV) in the adventitial layer of the carotid is proposed as an early alteration of atheromatous disease, which precedes the intima-media thickness. However, there is not any study that evaluates the association between NAFLD and VV.

Methods: A cross-sectional study was performed with 54 subjects undergoing bariatric surgery. Before surgery, all patients were subjected to a contrast-enhanced ultrasound study to evaluate carotid density of VV, to measure the thickness of intima-media and to verify the presence of atheromatous plaque. Whilst surgery a liver biopsy was performed.

Results: From liver biopsy, we regarded that 42 subjects had simple steatosis and 12 had steatohepatitis. The mean density of VV was similar between subjects with steatosis and subjects with steatohepatitis (0.742±0.173 vs. 0.781±0.136 arbitrary units (AU), P=0.481). In addition, there were no difference in carotid intima-media thickness (0.742±0.173 vs. 0.781±0.136 AU, P=0.481). We did not find any significative lineal correlation between mean density of VV and the carotid intima-media thickness (r=0.036, P=0.799), as well as there was not correlation with clinical parameters such as age (r=-0.128, P=0.346), BMI (r=0.066, P=0.627), fasting plasma glycaemia (r=0.118, P=0.390), HbA1c (r=134, P=0.342), the ‘fatty liver index’ (r=0.024, P=0.863) nor levels of GOT (r=0.067, P=0.623), GPT (r=0.009, P=0.945) and GGT (r=-0.099, P=0.467). From the multivariate analysis, we did not observe any clinical or analytic variable that correlates with the adventitial VV density in an independent way. Nevertheless, when carotid intima-media thickness was the dependent variable, we found that age correlated independently in the multivariate study, whilst the other variables did not correlate.

Conclusion: NAFLD disease is a comorbidity associated with severe obesity almost inevitably. However, there is insufficient evidence to suggest that NAFLD plays a key role in the initial development of obesity-associated cardiovascular disease.