Fatty liver is an independent predictor of early carotid atherosclerosis

Background & Aims: Whether steatosis is incidentally or causally associated with carotid atherosclerosis is debated, and long-term follow-up data are missing. This study aims to examine the impact of steatosis on the presence and progression of carotid intima-media thickness (C-IMT) and carotid plaques (CP) in a large cohort with longitudinal follow-up. Methods: A retrospective single-center study between 1995 and 2012. Transversal cohort: patients with P2 cardiovascular risk factors without previous cardiovascular events. Longitudinal cohort: patients with two consecutive C-IMT measurements more than 2 years apart. Steatosis was defined by a surrogate marker, the fatty liver index (FLI). CP and C-IMT were assessed by carotid ultrasound. Results: In the transversal cohort (n = 5671) both C-IMT and the Framingham risk score (FRS) increased across FLI quartiles (0.58 +/- 0.12, 0.61 +/- 0.14, 0.63 +/- 0.14, 0.64 +/- 0.14 mm, and 5 +/- 5%, 9 +/- 7%, 12 +/- 8%, 15 +/- 9%, p < 0.001 for both). Steatosis predicted C-IMT better than diabetes or dyslipidemia. Steatosis independently predicted C-IMT (p = 0.002) and FRS (p < 0.001) after adjustment for metabolic syndrome and cardiovascular risk factors. In the longitudinal cohort (n = 1872, mean follow-up 8 +/- 4 years), steatosis occurred in 12% and CP in 23% of patients. C-IMT increased in patients with steatosis occurrence (from 0.60 +/- 0.13 mm to 0.66 +/- 0.14 mm, p = 0.001) whereas it did not change in those that stayed free of steatosis. Steatosis at baseline predicted CP occurrence (OR = 1.63, 95% CI 1.10-2.41, p = 0.014), independent of age, sex, type-2 diabetes, tobacco use, hsCRP, hypertension and C-IMT. Conclusions: In patients with metabolic syndrome at risk for cardiovascular events, steatosis contributes to early atherosclerosis and progression thereof, independent of traditional cardiovascular risk factors. (C) 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.