NONALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH CORONARY DISEASE
                    FROM A BRAZIL NORTHEAST AREA

VILAR, Consuêlo Padilha; COTRIM, Helma Pinchemel; FLORENTINO, Gesira Soares Assis; BRAGAGNOLI, Gerson; SCHWINGEL, Paulo Adriano; BARRETO, Cibelle Padilha Vilar

doi:10.1590/S0004-28032015000200007

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Original Articles • Arq. Gastroenterol. 52 (2) • Apr-Jun 2015 • https://doi.org/10.1590/S0004-28032015000200007 copy

NONALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH CORONARY DISEASE FROM A BRAZIL NORTHEAST AREA

Doença hepática gordurosa não alcoólica em pacientes com doença coronariana de uma área do Nordeste do Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background

Nonalcoholic fatty liver disease (NAFLD) is the most frequent chronic liver injury around the world. It is associated with metabolic syndrome and cardiovascular diseases.

Objective

To evaluate the frequency and relevance of NAFLD in patients with coronary artery disease (CAD).

Methods

Patients from a Brazil Northeast area, who underwent elective coronary angiography (CAG) from 2009 to 2010 were included. All of them had suspicion of CAD. Criteria to CAD: presence of obstructive lesions in the epicardial coronary arteries, or in their major branches. NAFLD criteria: presence of hepatic steatosis on ultrasound; exclusion of other liver diseases; ethanol intake ≤ 20g/day. Statistics analysis included Independent t-test, Mann-Whitney and Pearson’s chi-squared test. Multivariate regression analysis measured the relationship between the risk factors and the concomitant presence of CAD and NAFLD.

Results

A total of 244 patients were evaluated: 63.5% had CAD and 42.2% had NAFLD. NAFLD was observed in 43.9% of the CAD patients. The regression analysis showed that the relationship between CAD and NAFLD was positively correlated with HOMA-IR ≥3.0 or insulin resistance and overweight/obesity.

Conclusion

NAFLD was frequent among CAD patients; insulin resistance and overweight/obesity were the most relevant risk factors related to the association NAFLD and CAD. The results suggest that patients with CAD should be evaluated for NAFLD.

HEADINGS
Fatty liver; Coronary artery disease; Cardiovascular diseases; Coronary angiography

Variables	All patients (n=244)
Age (years)	61.5 ± 9.3
Male, n (%)	126 (51.6)
Hypertension, n (%)	203 (83.2)
Diabetes Mellitus, n (%)	66 (27.0)
Fast insulin (µUI/mL)	9.1 ± 8.5
HOMA-IR	2.8 ± 3.1
HOMA ≥3.0, n (%)	68 (27.9)
BMI (kg/m²)	28.0 ± 4.5
Waist circumference (cm)	99.3 ± 11.4
Central obesity, n (%)	147 (60.2)
Overweight/obesity, n (%)	182 (74.6)
Neck circumference (cm)	38.2 ± 3.6
Metabolic syndrome, n (%)	168 (68.9)
Smoking, n (%)	141 (57.8)
Use of statin therapy, n (%)	112 (45.9)
TC (mg/dL)	192.9 ± 54.2
HDL-cholesterol (mg/dL)	41.2 ± 9.7
LDL-cholesterol (mg/dL)	112.6 ± 42.5
Triglycerides (mg/dL)	200.3 ± 14.3
AST (U/L)	24.4 ± 13.5
ALT (U/L)	30.8 ± 20.0
Ferritin (ng/mL)	178.4 ± 169.3
GGT (U/L)	45.1 ± 53.2
CAD, n (%)	155 (63.5)
NAFLD, n (%)	103 (42.2)

Variables	Coronary artery disease			P Value
	Total	Present	Absent
	(n=244)	(155)	(89)
Age (years)	61.5 ± 9.3	62.3 ± 9.3	60.0 ± 9.0	0.067
Male, n (%)	126 (51.6)	99 (63.9)	27 (30.3)	<0.001
Hypertension, n (%)	203 (83.2)	126 (81.3)	77 (86.5)	0.293
Diabetes Mellitus, n (%)	66 (27.0)	51 (32.9)	15 (16.9)	0.007
Smoking, n (%)	141 (57.8)	97 (62.6)	44 (49.4)	0.045
Waist circumference (cm)	99 ± 11	99 ± 10	100 ± 13	0.567
Central obesity, n (%)	147 (60.2)	85 (54.8)	62 (69.7)	0.023
Neck circumference (cm)	38 ± 4	39 ± 3	37 ± 3	0.015
Body mass index (kg/m²)	28.0 ± 4.5	27.6 ± 4.2	28.7 ± 5.0	0.084
Overweight/obesity, n (%)	182 (74.6)	114 (73.5)	68 (76.4)	0.622
Metabolic syndrome, n (%)	168 (68.9)	104 (67.1)	64 (71.9)	0.434
Fasting insulin (µUI/mL)	9.1 ± 8.6	10.0 ± 10.0	7.5 ± 4.5	0.008^(*)
HOMA-IR index	2.8 ± 3.1	3.0 ± 3.5	2.3 ± 2.4	0.098^(*)
HOMA-IR ≥3.0, n (%)	68 (27.9)	49 (32.9)	19 (22.6)	0.098
Total cholesterol (mg/dL)	192.9 ± 54.2	185.1 ± 54.5	206.4 ± 51.2	0.003
HDL cholesterol (mg/dL)	41.2 ± 9.7	38.9 ± 8.4	45.3 ± 10.5	<0.001
LDL cholesterol (mg/dL)	112.6 ± 42.5	107.7 ± 42.4	120.6 ± 41.6	0.026
Triglycerides (mg/dL)	200.2 ± 143.2	203.9 ± 159.6	193.8 ± 109.4	0.596
AST (U/L)	24.4 ± 13.5	24.3 ± 12.8	24.7 ± 14.8	0.847
ALT (U/L)	30.8 ± 20.0	31.8 ± 19.7	29.2 ± 20.4	0.326
Ferritin (ng/mL)	178.4 ± 169.3	205.6 ± 194.2	131.1 ± 98.7	<0.001^(*)
GGT (U/L)	45.0 ± 53.2	49.6 ± 61.6	37.0 ± 32.2	0.074^(*)
Use of statin therapy, n (%)	112 (45.9)	89 (57.4)	23 (25.8)	<0.001
NAFLD, n (%)	103 (42.2)	68 (43.9)	35 (39.3)	0.489

Variables	Total (n=244)	Nonalcoholic liver disease		P value
Variables	Total (n=244)	Present (n=103)	Absent (n=141)	P value
Age (years)	61.5 ± 9.3	60.7 ± 9.0	62.0 ± 9.5	0.259
Male, n (%)	126 (51.6)	52 (50.5)	74 (52.5)	0.758
Hypertension, n (%)	203 (83.2)	84 (81.6)	119 (84.4)	0.557
Diabetes Mellitus, n (%)	66 (27.0)	38 (36.9)	28 (19.9)	0.003
Smoking, n (%)	141 (57.8)	54 (52.4)	87 (61.7)	0.147
Waist circumference (cm)	99 ± 11	104 ± 9	95 ± 11	<0.001
Central obesity, n (%)	147 (60.2)	75 (72.8)	72 (51.1)	0.001
Neck circumference (cm)	38 ± 4	39 ± 3	37 ± 3	<0.001
Body mass index (kg/m²)	28.0 ± 4.5	30.2 ± 4.1	26.4 ± 4.2	<0.001
Overweight/obesity, n (%)	182 (74.6)	95 (92.2)	87 (47.8)	<0.001
Metabolic syndrome, n (%)	168 (68.9)	79 (76.7)	89 (63.1)	0.024
Fasting insulin (µUI/ml)	9.1 ± 8.6	11.4 ± 8.9	7.4 ± 7.9	<0.001^(*)
HOMA-IR index	2.8 ± 3.1	3.6 ± 3.0	2.2 ± 3.1	0.001^(*)
HOMA-IR ≥3.0, n (%)	68 (27.9)	45 (45.5)	23 (17.2)	<0.001
Total Cholesterol (mg/dL)	192.9 ± 54.2	193.6 ± 52.7	192.4 ± 55.4	0.864
HDL cholesterol (mg/dL)	41.2 ± 9.7	39.8 ± 9.1	42.3 ± 10.0	0.043
LDL cholesterol (mg/dL)	112.6 ± 42.5	108.8 ± 39.3	115.1 ± 44.5	0.268
Triglycerides (mg/dL)	200.2 ± 142.2	232.3 ± 172.4	176.8 ± 112.4	0.005
AST (U/L)	24.5 ± 13.6	25.7 ± 13.9	23.5 ± 13.2	0.224
ALT (U/L)	30.8 ± 20.0	35.3 ± 21.9	27.6 ± 17.9	0.003
Ferritin (ng/mL)	178.4 ± 169.3	205.4 ± 191.0	158.4 ± 149.0	0.032^(*)
GGT (U/L)	45.0 ± 53.2	47.2 ± 36.1	43.5 ± 62.8	0.586^(*)
Use of statin therapy, n (%)	112 (45.9)	44 (42.7)	68 (48.2)	0.394
CAD, n (%)	155 (63.5)	68 (66.0)	87 (61.7)	0.489

Variables	Total (n=155)	NAFLD		P Value
Variables	Total (n=155)	Present (n=68)	Absent (n=87)	P Value
Age (years)	62.3 ± 9.3	60.7 ± 9.3	63.6 ± 9.2	0.053
Gerder: Male, n (%)	99 (63.9)	41 (60.3)	58 (66.7)	0.412
Gerder: Female, n (%)	56 (36.1)	27 (39.7)	29 (33.3)
Hypertension, n (%)	126 (81.3)	53 (77.9)	73 (83.9)	0.344
Diabetes Mellitus, n (%)	51 (32.9)	27 (39.7)	24 (27.6)	0.111
Smoking, n (%)	97 (62.6)	40 (58.8)	57 (65.5)	0.393
Central obesity, n (%)	85 (54.8)	45 (66.2)	40 (46.0)	0.012
Neck circumference (cm)	38.6 ± 3.5	39.8 ± 3.2	37.7 ± 3.5	<0.001
Overweight/obesity, n (%)	114 (73.5)	63 (92.6)	51 (58.6)	<0.001
Metabolic syndrome, n (%)	104 (67.1)	49 (72.1)	55 (63.2)	0.245
Use of statin therapy, n (%)	89 (57.4)	36 (52.9)	53 (60.9)	0.319
Fasting insulin (µUI/mL)	10.0 ± 10.0	12.3 ± 10.1	8.2 ± 9.7	0.014^(*)
HOMA-IR ≥3.0, n (%)	49 (32.9)	34 (50.0)	16 (19.3)	<0.001^(*)
TC (mg/dL)	185.1 ± 54.5	186.2 ± 46.8	184.3 ± 60.1	0.882
HDL-cholesterol (mg/dL)	39.8 ± 8.4	37.7 ± 7.6	39.9 ± 8.9	0.110
LDL-cholesterol (mg/dL)	107.7 ± 42.4	106.5 ± 36.8	108.5 ± 46.4	0.770
Triglycerides (mg/dL)	203.9 ± 159.6	233.6 ± 187.3	180.7 ± 130.7	0.040
AST (U/L)	24.3 ± 12.8	24.6 ± 10.3	24.1 ± 14.6	0.800
ALT (U/L)	31.8 ± 19.7	34.2 ± 20.3	29.9 ± 19.2	0.173
Ferritin (ng/mL)	205.6 ± 194.2	231.5 ± 214.9	185.2 ± 174.7	0.041^(*)
GGT (U/L)	49.5 ± 61.6	47.2 ± 3 2.8	51.4 ± 77.1	0.668^(*)

Variables^(*)	Odds ratio	95% CI	P value
overweight/obesity	6.46	(2.29; 18.17)	<0.001
HOMA-IR ≥3.0	3.00	(1.40; 6.47)	0.005

Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE. Rua Dr. Seng, 320, 01331-020 São Paulo - SP Brasil, Tel./Fax: +55 11 3147-6227 - São Paulo - SP - Brazil
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[1] Correspondence: Prof.ª Helma Pinchemel Cotrim. Programa de Pós-graduação em Medicina e Saúde - PPGMS, Complexo Hospitalar Universitário Professor Edgard Santos, Rua Augusto Viana, s/n, 5º andar, Canela - CEP 40110-060 - Salvador, BA, Brasil. E-mail: hpcotrim@ufba.br