Markers of endothelial dysfunction in patients with non-alcoholic fatty liver disease and coronary artery disease

Background: Non-alcoholic fatty liver disease (NAFLD) has been associated with coronary artery disease (CAD) and cardiac-related mortality. Aim: To assess the association between endothelial dysfunction markers (Endocan, high mobility group box 1 [HMGB1], and anti-endothelial cell antibodies [AECAs]) and the risk of CAD in NAFLD. Methods: Ninety-one patients scheduled for coronary angiography for chest pain were included. Of these, 77 had NAFLD (85% with documented CAD). NAFLD was diagnosed after exclusion of other causes of liver diseases and by hepatic ultrasound and/or fatty liver index. Diagnosis and severity of CAD were established with coronary angiography. Endocan (ng/mL) and HMGB1 (ng/mL) concentrations were determined in the serum using enzyme-linked immunosorbent assay technique. AECAs were quantified in sera using flow cytometry. Results: NAFLD patients with CAD had higher serum endocan level as compared with NAFLD without CAD (P = 0.006). Furthermore, levels of endocan (odds ratio [OR] 38.66 [95% confidence interval {CI} 1.10-999.99]) and hyperlipidemia (OR 5.62 [95% CI 1.36-23.19]) were significantly associated with the risk of CAD and high serum high-density lipoprotein cholesterol level (OR 0.92 [95% CI 0.87-0.97]) was protective against CAD. On the other hand, serum level of HMGB1 was significantly lower in NAFLD patients with CAD than NAFLD patients without CAD (P = 0.0003). Interestingly, in our NAFLD cohort, serum endocan levels positively correlated the severity of CAD (r = 0.27; P < 0.05), whereas HMGB1 levels negatively correlated with severity of CAD (r = -0.35; P < 0.05). The levels of AECA were not significantly associated with CAD in NAFLD. Conclusion: Markers of endothelial dysfunction in patients NAFLD patients may be associated with the risk for CAD.