Liver Fat Storage Is a Better Predictor of Coronary Artery Disease than Visceral Fat

Fatty liver is one aspect of metabolic syndrome. The roles and contributions of fatty liver and visceral fat storage to coronary artery disease (CAD) are not clear. This study measured associations among visceral fat storage, fatty liver, insulin resistance, atherosclerosis, and CAD. Patients were divided into three groups: excess visceral fat (visceral fat area > 330 +/- 99 cm(2)), nonalcoholic fatty liver disease (NAFLD), and a control group. The definition of fatty liver is liver minus spleen density greater than or equal to 10. We defined early atherosclerosis as intima-media thickness of the common carotid artery > 7 mm in men and >0.65 mm in women, measured with Doppler ultrasound. Visceral fat area was defined using CT (> 330 +/- 99 cm(2)). Insulin-resistance biomarkers (HOMA), CRP, and oxidant-antioxidant status (MDA-Paraoxonase) were also measured. Patients with high liver or visceral fat showed higher coronary plaque prevalence (50% (p < 0.001), 38% (p < 0.01), respectively vs. 25% in the control group), higher prevalence of coronary stenosis (30% (p < 0.001), 22% (p < 0.01) vs. 11% in the control group), higher intimal thickening (0.98 +/- 0.3 (p< 0.01), 0.86 +/- 0.1 (p < 0.01) vs. 0.83 +/- 0.1 in the control group), higher HOMA (4.0 +/- 3.0 (p < 0.005), 3.0 +/- 1.0 (p < 0.001) vs. 1.5 +/- 1.2 in the control group), and higher triglyceride levels (196.8 +/- 103 (p < 0.005), 182.6 +/- 90.87 (p < 0.005) vs. 145 +/- 60 in the control group). Multiple logistic regression analysis showed that fatty liver predicted CAD (OR 2.7, 95% CI 2.3-4.9, p < 0.001) independently of visceral fat storage (OR 2.01, 95% CI 1.2-2.8, p < 0.001). Liver fat storage is a strong independent risk factor for CAD and carotid atherosclerosis and contributes more than visceral fat storage.