Endocrine Abstracts

Objective: Non-alcoholic fatty liver disease (NAFLD) is considered as a continuum from obesity and metabolic syndrome (MetS). To investigate the cardiovascular prognosis of metabolically healthy NAFLD, this study aimed to evaluate the association between NAFLD with and without MetS and change in coronary artery calcification (CAC).

Methods: This is a retrospective longitudinal study of 5,117 subjects without cardiovascular disease who participated in a health screening program. Ultrasonographic measurements of fatty liver and multi-detector computed tomography were concurrently performed to determine the CAC score. We classified the subjects into four groups according to NAFLD status and MetS presence: controls neither NAFLD nor MetS, NAFLD without MetS, MetS without NAFLD, and NAFLD with MetS. CAC progression was defined as [√CAC score (follow-up) − √CAC score (baseline)] ≥2.5.

Results: During median follow-up of 5.0 years, CAC progression was detected in 2,125 subjects (41.1%). After adjustment for age, diabetes, hypertension, triglycerides, HDL-cholesterol, use of lipid-lowering drugs, smoking status, and baseline CAC score, the hazard ratios (HRs) for CAC progression comparing controls, those of NAFLD without MetS, MetS without NAFLD, and NAFLD with MetS were 1.21 (95% CI: 1.08–1.35), 1.04 (0.85–1.27) and 1.36 (1.15–1.56), respectively. When NAFLD without MetS were stratified by the severity of ultrasonographic findings, subjects with moderate to severe NAFLD had a higher risk of CAC progression, compared to those without NAFLD or mild NAFLD. The prognostic factors for CAC progression were higher HbA1c, fasting plasma glucose, aspartate transaminase, γ-glutamyltransferase, and baseline CAC score in subjects with metabolically healthy NAFLD.

Conclusions: NAFLD without MetS was significantly associated with an increased risk of CAC progression regardless of other cardiometabolic risk factors. NAFLD without MetS might be considered to have an intermediate metabolic phenotype between healthy individuals and NAFLD patients with MetS.