DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20201912

Relation between non-alcoholic fatty liver disease and ischemic heart disease studied at rural tertiary care centre in Uttar Pradesh, India

Granth Kumar, Ganga Prasad Vaishya, Vijayavarman V., Saleem Ahmad, Pawan Kumar, Rahul Kumar

Abstract


Background: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the United States and other industrialized countries, many study has identified NAFLD as a risk factor not only for premature coronary artery disease and cardiovascular events, but also for early subclinical abnormalities in myocardial structure and function. Aim of this study was to the presence of NAFLD in patients with Ischemic Heart Disease (IHD) and Relation of NAFLD with other risk factors of IHD.

Methods: The study group consisted of 150 patients that comply with inclusion criteria and selected of 100 consecutive patients who underwent coronary angiographies. Coronary artery disease was defined as a stenosis at least 50% in at least one major coronary artery. Fatty liver was diagnosed by abdominal ultrasonography (4 stages: Grades 0, 1, 2 and 3). Statistical evaluations were performed using T test, Chi- square test.

Results: The present study was done in 100 patients of coronary artery disease divided into two groups i.e. Non NAFLD group n= 62 (62%) and NAFLD group n= 38 (38%). The present study shows that the prevalence of NAFLD was highest (86.8%) in more than 40 years of age group. The present study shows that the prevalence of NAFLD was more in males (84.2%) as compare to females (15.8%). The present study also shows significantly high incidence of metabolic syndrome in patients with NAFLD (23.7%) as compared to Non-NAFLD (3.2%) patients with Coronary Artery (CAD).

Conclusions: The presence of fatty liver and its severity should be carefully considered as independent risk factors for IHD. The study results suggest the synergistic effect in between fatty liver and deranged lipid profile for developing IHD. Abdominal ultrasonography may provide valuable information about IHD risk assessment.


Keywords


Ischemic heart disease, Metabolic syndrome, Non-alcoholic fatty liver disease, Rural area

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References


Bhatia LS, Curzen NP, Calder PC, Byrne CD. Non-alcoholic liver disease: A New and important cardiovascular risk factor. European Heart J. 2012;33:1190-200.

Kumar V, Abbas AK, Aster JC, Parkins JA. Robbins and Cotran pathologic basis of disease. 9th edition. Saunders Elsevier; 2015:538-550.

Kotronen A, Juurinen L, Tiikkainen M, Vehkavaara S, Yki-Jarvinen H. Increased liver fat, impaired insulin clearance and hepatic and adipose tissue insulin resistance in type 2 diabetes. Gastroenterol. 2008;135:122-30.

Bugianesi E, Gastaldelli A. Hepatic and cardiac steatosis: Are they coupled? Heart Fail. Clin. 2012;8:663-70.

Feitosa MF, Reiner AP, Wojczynski MK, Graff M, North KE, Carr JJ, et al. Sex-influenced association of nonalcoholic fatty liver disease with coronary heart disease. Atheroscler. 2013;227:420-24.

Akın L, Kurtoglu S, Yikilmaz A, Kendirci M, Elmalı F, Mazicioglu M. Fatty liver is a good indicator of subclinical atherosclerosis risk in obese children and adolescents regardless of liver enzyme elevation. Acta Paediatr. 2013;102:e107-13.

Saadeh S, Younossi ZM, Remer EM, Gramlich T, ONG JP, Hurley M, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterol. 2002;123(3):745-50.

Alberti KG, Zimmet P, Shaw J. Metabolic Syndrome - a new worldwide definition. A consensus statement from the International Diabetes Federation (IDF). Diabetic Med. 2006;23(5):469-80.

Expert panel on detection, evaluation and treatment of high blood cholesterol in adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486-97.

Kalra S, Vithalani M, Gulati G, Kulkarni CM, Kadam Y, Pallivathukkal J, et al. Study of prevalent of nonalcoholic fatty liver disease in type 2 diabetes patient in India. J Asso Physician India. 2013;61(7):448-53.

Sonsuz A, Özdemir MB, Başaranoğlu M, Şentürk A, Akın P. Metabolic disorders associated with nonalcoholic steatohepatitis: an analysis of risk factors. European Association for the Study of the Liver and Turkish Association for the Study of the Liver. Easl Postgraduate Course-First Hepatology Day, 1998 June 26-27. Proceedings. Istanbul. 1998:49.

Bajaj S, Nigam P, Luthra A, Pandey RM, Kondal D, Bhatt SP, et al. A case control study on insulin resistance, metabolic co-variates and prediction score in nonalcoholic fatty liver disease. Indian J Med Res. 2009;129(3):285-92.

Kwon YM, Oh SW, Hwang SS, Lee C, Kwon H, Chung GE. Association of non-alcoholic fatty liver disease with components of metabolic syndrome according to body mass index in Korean adults. Am J Gastroenterol. 2012;107(12):1852-8.

Viswanathan V, Kadiri M, Medimpudi S, Kumpatla S. Association of non-alcoholic fatty liver disease with diabetic microvascular and macrovascular complication in South Indian diabetic subjects. Int J Diabetes Developing Countries. 2010;30(4):208-12.

Fan JG, Saibara T, Chitturi S, Kim BI, Sung JJ, Chutaputti A. What are the risk factors and setting for non-alcoholic fatty liver disease in Asia Pacific? J Gastroenterol Hepatol. 2007;22(6):794-800.

Gupte P, Amarapurkar D, Agal S, Baijal R, Kulshrestha P, Pramanik S, et al. Non-alcoholic steatohepatitis in type 2 diabetes mellitus. J Gastroenterol Hepatol. 2004;19(8):854-8.

Rocha R, Cotrim HP, Carvalho FM, Siqueira AC, Braga H, Freitas LA. Body mass index and waist circumference in non-alcoholic fatty liver disease. J Human Nutrition Dietetics 2005;18(5):365-70.

Pagano G, Pacini G, Musso G, Gambino R, Mecca F, Depetris N, et al. Nonalcoholic steatohepatitis, insulin resistance and metabolic syndrome: further evidence for an etiologic association. Hepatol. 2002;35(2):367-72.

Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatol. 2004;40:1387-95.

Gastaldelli A, Kozakova M, Hojlund K, Flyvbjerg A, Favuzzi A, Mitrakou A, et al. Fatty liver is associated with insulin resistance, risk of coronary heart disease and early atherosclerosis in a large European population. Hepatol. 2009;49:1537-44.

Targher G, Bertolini L, Poli F, Rodella S, Scala L, Tessari R, et al. Non-alcoholic fatty liver disease and risk of future cardiovascular events among type 2 diabetic patients. Diabetes. 2005;54(12):3541-6.

Lin YC, Lo HM, Chen JD. Sonographic fatty liver, overweight and ischemic heart disease. World J Gastroenterol. 2005;11:4838-42.

Alkhouri N, Tamimi TAR, Yerian L, Lopez R, Zein NN, Feldstein AE. The inflamed liver and atherosclerosis: a Link between histologic severity of nonalcoholic fatty liver disease and increased cardiovascular risk. Dig Dis Sci. 2010;55(9):2644-50.

Schindler TH, Nitzsche EU, Olschewski M, Magosaki N, Mix M, Prior JO, et al. Chronic inflammation and impaired coronary vasoreactivity in patients with coronary risk factors. Circulation. 2004;110:1069-75.

Kerner A, Avizohar O, Sella R, Bartha P, Zinder O, Markiewicz W, et al. Association between elevated liver enzyme and C-reactive protein: possible hepatic contribution to systemic inflammation in the metabolic syndrome. Arterioscler Thromb Vasc Biol. 2005;25(1):193-7.