Brief Article
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World J Gastroenterol. Oct 14, 2013; 19(38): 6453-6457
Published online Oct 14, 2013. doi: 10.3748/wjg.v19.i38.6453
Nonalcoholic fatty liver disease is associated with coronary artery disease in Koreans
Dae Hee Choi, Sung Joon Lee, Chang Don Kang, Myoung Ok Park, Dong Wook Choi, Tae Suk Kim, Wonho Lee, Byung Ryul Cho, Yong Hoon Kim, Bong-ki Lee, Dong Ryeol Ryu, Ji Won Lee
Dae Hee Choi, Sung Joon Lee, Chang Don Kang, Myoung Ok Park, Dong Wook Choi, Tae Suk Kim, Wonho Lee, Byung Ryul Cho, Yong Hoon Kim, Bong-ki Lee, Dong Ryeol Ryu, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 200-701, South Korea
Ji Won Lee, Department of Radiology, Kangwon National University School of Medicine, Chuncheon 200-701, South Korea
Author contributions: Choi DH contributed to conception and design, reviewed the literature and drafted the paper; Lee SJ, Kang CD, Park MO, Choi DW, Kim TS, Lee W, Cho BR, Kim YH, Lee B and Lee JW collected data; Ryu DR reviewed data and edited the paper.
Supported by A 2009 Research Grant from Kangwon National University
Correspondence to: Dong Ryeol Ryu, MD, Associate Professor of Internal Medicine, Department of Internal Medicine, Kangwon National University School of Medicine, Hyoja-dong, Chuncheon 200-701, South Korea. rdr0203@hanmail.net
Telephone: +82-33-2582454 Fax: +82-33-2582404
Received: June 20, 2013
Revised: August 12, 2013
Accepted: August 20, 2013
Published online: October 14, 2013
Processing time: 117 Days and 0.9 Hours
Abstract

AIM: To investigate whether nonalcoholic fatty liver disease (NAFLD) affects coronary artery disease (CAD) and identify candidate mediators.

METHODS: Patients who underwent coronary angiography were consecutively recruited. The patients were classified into four groups by coronary artery stenosis: A, insignificant; B, one-vessel disease; C, two-vessel disease; and D, three-vessel disease. Abdominal ultrasonography was performed to determine the presence of a fatty liver and categorize by grade: 0, no evidence; 1, mild; 2, moderate; and 3, severe. We measured not only known CAD risk factors, but also serum insulin, HOMA-index, adiponectin, interleukin-6, tumor necrosis factor-α and high-sensitivity C-reactive protein levels.

RESULTS: Of the 134 patients who met the inclusion criteria, 82 (61.2%) had ultrasonographically diagnosed NAFLD. Among the 46 patients with CAD, 37 (80.4%) had evidence of a fatty liver. The two groups (A vs B-D) were significantly different in terms of age, total cholesterol, triglycerides, low-density lipoprotein levels and fatty liver. Coronary artery stenosis was strongly associated with fatty liver in a grade-dependent manner (P = 0.025). In binary logistic regression, NAFLD was a significant independent predictor of CAD (P = 0.03, OR = 1.685; 95%CI: 1.051-2.702). Among the candidate mediators, the serum adiponectin level showed a trend toward lowering based on CAD progression (P = 0.071).

CONCLUSION: NAFLD is an independent risk factor for CAD in a grade-dependent manner. Moreover, adiponectin might be related to the pathogenesis of NAFLD.

Keywords: Nonalcoholic fatty liver disease; Coronary artery disease; Coronary angiography; Adiponectin; Insulin resistance

Core tip: This article shows that angiographically proven coronary artery stenosis is strongly associated with nonalcoholic fatty liver disease (NAFLD) in a grade-dependent manner. Although many recent studies used coronary artery calcification score, carotid artery intima-media thickness, or carotid artery plaque measurements as surrogate markers for coronary artery disease (CAD), we evaluated the interaction between fatty liver and cardiovascular outcomes using coronary angiograms in a prospective case-controlled study. Because the pathogenesis of NAFLD and CAD is not fully elucidated, we attempted to identify mediators of these diseases and believe that adiponectin might be related to the development and progression of CAD in patients with NAFLD.