Impact of Steatosis on Atherosclerotic Risk Factors in Diabetic Patients with Non-Alcoholic Fatty Liver Disease

Presentation Number: SAT 514
Date of Presentation: April 1st, 2017

Fatimah Zaherah Mohamed Shah*1, Nurazam Omar2, Faradila Hatta3, Marymol Koshy2, Sazzli Sahlan Kasim2 and Rohana Abdul Ghani2
1Universiti Teknologi MARA, Kuala Lumpur, Malaysia, 2Universiti Teknologi MARA, Selangor, Malaysia, 3Universiti Teknologi MARA, Shah Alam, MALAYSIA

Abstract

Background and Aims: NAFLD and metabolic syndrome have been shown to have a synergistic impact on atherosclerosis. Carotid intima-media thickness (CIMT) is a reliable index of subclinical atherosclerosis. The relationships between glycaemic control and degree of steatosis with CIMT in patients with NAFLD remain vague. Thus, this study aimed to determine the effects of varying degrees of steatosis and glycated haemoglobin (HbA1c) on atherosclerotic risk factors including CIMT among a high risk population of type 2 diabetes mellitus (T2DM) with established coronary artery disease (CAD) and newly identified NAFLD. Materials and Methods. This is a cross-sectional study involving T2DM patients between 18 to 65 years old with established CAD based on coronary angiogram, dobutamine stress echocardiogram or treadmill stress test (n=150). Patients with seropositive Hepatitis B or Hepatitis C, and alcohol intake more than 21 units per week for males and more than 14 units per week for females were excluded. Baseline blood investigations were performed. Participants underwent ultrasonography of the abdomen by 2 independent radiologists for diagnosis of fatty liver, and further grouped into mild, moderate, severe and no steatosis. B-mode ultrasonography of both common carotid arteries was also performed, with calculation of the average posterior wall intima media thickness of the right and left common carotid arteries to determine CIMT. Results. There were 114 (76 %) males and 36 (24 %) females, with median age 57 years (IQR 13) and mean body mass index (BMI) 29.6 ± 15.3 kg/m2. The prevalence of NAFLD was 71.3 % (n=107), with higher BMI and waist circumference in the NAFLD vs non-NAFLD group. Systolic blood pressure was significantly higher in patients with NAFLD 135 ± 16.6 mmHg vs 127 ± 15.7 mmHg (p<0.001). Median HbA1c was significantly highest within the moderate steatosis group, followed by mild steatosis group and the no NAFLD group (9.3% (IQR 2.4) vs 8.2% (IQR 5.8) vs 8.0% (IQR 2.2) p <0.001). Similarly, patients with moderate NAFLD had significantly higher mean CIMT value, followed by mild steatosis group and the no NAFLD group (0.77 mm ± 0.19 vs 0.69 mm± 0.14 vs 0.68 mm± 0.32, p value 0.01). HbA1c was significantly correlated with CIMT in the NAFLD group, r=0.324 (p=0.002) but not in the non-NAFLD group r=0.095 (p=0.606). Conclusion. In this cohort of T2DM patients with established CAD, patients with NAFLD had higher obesity parameters, blood pressure and HbA1c compared to those without NAFLD. Patients with moderate steatosis had higher HbA1c and CIMT values compared to the mild and no steatosis groups. Our findings suggested additional atherosclerotic risks within the NAFLD group with significantly higher CIMT associated with higher HbA1c, which was not seen within the non-NAFLD group.

 

Nothing to Disclose: FZM, NO, FH, MK, SSK, RA