1
|
Mumtaz A, Rehman N, Haider A, Rehman S. Long-Term Air Pollution Exposure and Ischemic Heart Disease Mortality Among Elderly in High Aging Asian Economies. Front Public Health 2022; 9:819123. [PMID: 35198535 PMCID: PMC8860192 DOI: 10.3389/fpubh.2021.819123] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/21/2021] [Indexed: 01/01/2023] Open
Abstract
In the epidemiological literature, the impact of environmental pollution on cardiac mortality has been well documented. There is, however, a paucity of evidence on the impact of air pollution exposure on ischemic heart disease (IHD) mortality among the Asian aged population. In response, this research seeks to investigate the degree of proximity between exposure to ambient PM2.5, household PM2.5, ground-level ozone (O3), and IHD mortality in the top seven Asian economies with the highest aging rates. This investigation is held in two phases. In the first phase, grey modeling is employed to assess the degree of proximity among the selected variables, and then rank them based on their estimated grey weights. In addition, a grey-based Technique for Order of Preference by Similarity to Ideal Solution (G-TOPSIS) is adopted to identify the key influencing factor that intensifies IHD mortality across the selected Asian economies. According to the estimated results, South Korea was the most afflicted nation in terms of IHD mortality owing to ambient PM2.5 and ground-level O3 exposure, whereas among the studied nations India was the biggest contributor to raising IHD mortality due to household PM2.5 exposure. Further, the outcomes of G-TOPSIS highlighted that exposure to household PM2.5 is a key influencing risk factor for increased IHD mortality in these regions, outweighing all other air pollutants. In conclusion, this grey assessment may enable policymakers to target more vulnerable individuals based on scientific facts and promote regional environmental justice. Stronger emission regulations will also be required to mitigate the adverse health outcomes associated with air pollution exposure, particularly in regions with a higher elderly population.
Collapse
Affiliation(s)
- Ayesha Mumtaz
- School of Public Administration, Hangzhou Normal University, Hangzhou, China
- College of Public Administration, Zhejiang University, Hangzhou, China
| | - Nadia Rehman
- Department of Mathematics, COMSATS University, Islamabad, Pakistan
| | - Aftab Haider
- Business Studies Department, Bahria University, Islamabad, Pakistan
| | - Shazia Rehman
- Department of Biomedical Sciences, Pak-Austria Fachhochschule, Institute of Applied Sciences and Technology, Haripur, Pakistan
- *Correspondence: Shazia Rehman
| |
Collapse
|
2
|
Abstract
PURPOSE OF REVIEW Nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are strongly associated. Both also associate with an increased risk of cardiovascular disease (CVD). RECENT FINDINGS Several studies have provided evidence that NAFLD could be an independent CVD risk factor. Given the strong association between NAFLD and T2DM, assessing the independent CV effect of these two conditions remains challenging. However, patients with T2DM and NAFLD exhibit higher risk of CVD compared with T2DM without NAFLD suggesting a potential synergistic increase of CV risk in patients with both T2DM and NAFLD supported by several shared pathophysiological pathways. Several anti-diabetic therapies have shown beneficial effect on both NAFLD and CVD. Patients with T2DM and NAFLD should be considered at high risk of CVD and could benefit from more intensive CV prevention. Additional long-term follow-up is needed to demonstrate that the treatment of NAFLD effectively reduces the risk of CVD.
Collapse
Affiliation(s)
- Cyrielle Caussy
- Hôpital Lyon Sud, Département Endocrinologie, Diabète et Nutrition, Hospices Civils de Lyon, 69495, Pierre-Bénite, France.
| | - Adrien Aubin
- Hôpital Lyon Sud, Département Endocrinologie, Diabète et Nutrition, Hospices Civils de Lyon, 69495, Pierre-Bénite, France
| | - Rohit Loomba
- Department of Medicine, NAFLD Research Center, University of California at San Diego, La Jolla, CA, USA.
- Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA.
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA, USA.
| |
Collapse
|
3
|
Veracruz N, Hameed B, Saab S, Wong RJ. The Association Between Nonalcoholic Fatty Liver Disease and Risk of Cardiovascular Disease, Stroke, and Extrahepatic Cancers. J Clin Exp Hepatol 2021; 11:45-81. [PMID: 33679048 PMCID: PMC7897860 DOI: 10.1016/j.jceh.2020.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & AIMS Although primarily a disease with liver-specific complications, nonalcoholic fatty liver disease (NAFLD) is a systemic disease with extrahepatic complications. We aim to evaluate the association between NAFLD and cardiovascular disease (CVD), stroke and cerebrovascular disease, and extrahepatic cancers. METHODS We searched MEDLINE, EMBASE, and Cochrane Systematic Review Database from January 1, 2000 to July 1, 2019 to identify peer-reviewed English language literature using predefined keywords for NAFLD, CVD, stroke and cerebrovascular disease, and extrahepatic cancers among adults. Two reviewers independently selected studies for inclusion. Measures of association between NAFLD and CVD, stroke and cerebrovascular disease, and extrahepatic cancers were extracted. Quality assessed using Newcastle-Ottawa scale and Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Thirty studies were included evaluating CVD, 16 studies evaluating stroke or cerebrovascular disease, and 13 studies evaluating extrahepatic cancers. On pooled meta-analysis assessment, NAFLD was associated with increased risk of CVD (risk ratio [RR]: 1.78; 95% confidence interval [CI]: 1.52-2.08) and stroke or cerebrovascular disease (RR: 2.08, 95% CI: 1.72-2.51). Significant heterogeneity in assessing extrahepatic cancers prevented applying meta-analysis methods, but NAFLD seemed to be associated with increased risk of breast and colorectal cancers. Overall level of quality of studies were very low by GRADE. CONCLUSIONS NAFLD is associated with increased risks of CVD and stroke or cerebrovascular disease among adults. There appears to be increased risk of breast and colorectal cancers. Given low quality of evidence, it is premature to make any strong conclusions to modify CVD, stroke, or cancer screening policies in patients with NAFLD.
Collapse
Affiliation(s)
- Nicolette Veracruz
- College of Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | - Bilal Hameed
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA
| | - Sammy Saab
- Division of Gastroenterology and Hepatology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA, USA
- Address for correspondence:
| |
Collapse
|
4
|
Chiriac S, Stanciu C, Girleanu I, Cojocariu C, Sfarti C, Singeap AM, Cuciureanu T, Huiban L, Muzica CM, Zenovia S, Nastasa R, Trifan A. Nonalcoholic Fatty Liver Disease and Cardiovascular Diseases: The Heart of the Matter. Can J Gastroenterol Hepatol 2021; 2021:6696857. [PMID: 33505944 PMCID: PMC7815392 DOI: 10.1155/2021/6696857] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) has emerged as the most frequent cause of liver disease worldwide, comprising a plethora of conditions, ranging from steatosis to end-stage liver disease. Cardiovascular disease (CVD) has been associated with NAFLD and CVD-related events represent the main cause of death in patients with NAFLD, surpassing liver-related mortality. This association is not surprising as NAFLD has been considered a part of the metabolic syndrome and has been related to numerous CVD risk factors, namely, insulin resistance, abdominal obesity, dyslipidemia, hyperuricemia, chronic kidney disease, and type 2 diabetes. Moreover, both NAFLD and CVD present similar pathophysiological mechanisms, such as increased visceral adiposity, altered lipid metabolism, increased oxidative stress, and systemic inflammation that could explain their association. Whether NAFLD increases the risk for CVD or these diagnostic entities represent distinct manifestations of the metabolic syndrome has not yet been clarified. This review focuses on the relation between NAFLD and the spectrum of CVD, considering the pathophysiological mechanisms, risk factors, current evidence, and future directions.
Collapse
Affiliation(s)
- Stefan Chiriac
- 1Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
- 2Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, Iasi 700111, Romania
| | - Carol Stanciu
- 2Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, Iasi 700111, Romania
| | - Irina Girleanu
- 1Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
- 2Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, Iasi 700111, Romania
| | - Camelia Cojocariu
- 1Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
- 2Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, Iasi 700111, Romania
| | - Catalin Sfarti
- 1Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
- 2Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, Iasi 700111, Romania
| | - Ana-Maria Singeap
- 1Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
- 2Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, Iasi 700111, Romania
| | - Tudor Cuciureanu
- 1Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Laura Huiban
- 1Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Cristina Maria Muzica
- 1Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Sebastian Zenovia
- 1Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Robert Nastasa
- 1Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Anca Trifan
- 1Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
- 2Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, Iasi 700111, Romania
| |
Collapse
|
5
|
Motamed N, Ajdarkosh H, Ahmadi M, Perumal D, Ashrafi GH, Nikkhah M, Faraji AH, Maadi M, Khoonsari M, Rezaie N, Farahani B, Safarnezhad Tameshkel F, Ameli M, Panahi M, Karbalaie Niya MH, Zamani F. Non-alcoholic fatty liver disease is not independent risk factor for cardiovascular disease event: A cohort study. World J Hepatol 2020; 12:323-331. [PMID: 32742574 PMCID: PMC7364326 DOI: 10.4254/wjh.v12.i6.323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/08/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are no consistent results between previous studies for an independent association between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) events.
AIM To determine if there is an independent association between NAFLD and CVD events.
METHODS In the present study, valid outcome data of 4808 subjects were available for phase 2 of our cohort study. These subjects had been followed up for seven years from phase 1, beginning in 2009-2010 to phase 2 during 2016-2017. Simple and multiple Cox proportional models were used to determine the association between NAFLD in the primary phase of the cohort and subsequent fatal and non-fatal CVD events during follow-up.
RESULTS The incidence of non-fatal CVD events in males with NAFLD was significantly higher (P = 0.004) than in males without NAFLD. A positive association was demonstrated between NAFLD and non-fatal CVD events in males (Hazard ratio = 1.606; 95%CI: 1.166-2.212; P = 0.004) by the simple Cox proportional hazard model, but no independent association was detected between these in the multiple Cox models.
CONCLUSION No independent association was detected between NAFLD and CVD. It is likely that diabetes mellitus and age may be the principle mediators in this regard.
Collapse
Affiliation(s)
- Nima Motamed
- Department of Social Medicine, Zanjan University of Medical Sciences, Zanjan 1449614535, Iran
| | - Hossein Ajdarkosh
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Maral Ahmadi
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Dhayaneethie Perumal
- Faculty of Science, Engineering and Computing, Kingston University, Kingston, London KT1 2EE, United Kingdom
| | - G Hossein Ashrafi
- Cancer Theme SEC Faculty Penrhyn Road, Kingston University, London KT1 2EE, United Kingdom
| | - Mehdi Nikkhah
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Amir Hossein Faraji
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Mansooreh Maadi
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Mahmoodreza Khoonsari
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Nader Rezaie
- Department of Pulmonology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Behzad Farahani
- Department of Cardiology, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | | | - Mitra Ameli
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Mahshid Panahi
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Mohammad Hadi Karbalaie Niya
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Farhad Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| |
Collapse
|
6
|
Tan ECL, Tai MLS, Chan WK, Mahadeva S. Association between non-alcoholic fatty liver disease evaluated by transient elastography with extracranial carotid atherosclerosis in a multiethnic Asian community. JGH OPEN 2018; 3:117-125. [PMID: 31061886 PMCID: PMC6487823 DOI: 10.1002/jgh3.12114] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/14/2018] [Accepted: 10/25/2018] [Indexed: 12/17/2022]
Abstract
Background and Aim There is not much data on the association between non‐alcoholic fatty liver disease (NAFLD) and advanced fibrosis assessed using Fibroscan with carotid intima‐media thickness (CIMT) in the general population. The objective of this study was to evaluate the association between NAFLD and advanced fibrosis, as diagnosed by Fibroscan, with an increased CIMT in the Malaysian population. Methods A cross‐sectional study of government officers and their family members attending a health screening at a public healthcare facility was conducted. All subjects underwent clinical evaluation, biochemical testing, anthropometry, ultrasound carotid Doppler, and Fibroscan examination. Results Data for 251 subjects were analyzed (mean age 47.1 ± 12.4 years, 74.1% male). Prevalence of NAFLD and advanced fibrosis were 57.4 and 17.5%, respectively. Independent factors associated with NAFLD were waist circumference (odds ratio [OR] = 1.077, 95% confidence interval [CI] 1.038–1.118, P < 0.001) and serum alanine aminotransferase (ALT) (OR = 1.039, 95% CI 1.005–1.074, P = 0.024). Independent factors associated with advanced fibrosis were male gender (OR = 4.847, 95% CI 1.369–17.155, P = 0.014) and serum aspartate aminotransferase (AST) (OR = 1.057, 95% CI 1.003–1.113, P = 0.036). Prevalence of increased CIMT was 29.0%. Independent factor associated with increased CIMT was older age (OR = 1.146, 95% CI 1.067–1.231, P < 0.001). Of the subjects, 34.5% with NAFLD had increased CIMT compared to 19.1% of the subjects without NAFLD (P = 0.063). Advanced fibrosis was not associated with increased CIMT. Conclusions Prevalence of NAFLD, advanced liver fibrosis, and increased CIMT were high. NAFLD and advanced liver fibrosis appeared not to be associated with increased CIMT. However, a larger sample size is needed to demonstrate whether there is any association.
Collapse
Affiliation(s)
- Eugene Choon-Li Tan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia
| | - Mei-Ling Sharon Tai
- Division of Neurology, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia
| | - Sanjiv Mahadeva
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia
| |
Collapse
|
7
|
Synergistic increase in cardiovascular risk in diabetes mellitus with nonalcoholic fatty liver disease: a meta-analysis. Eur J Gastroenterol Hepatol 2018; 30:631-636. [PMID: 29351115 DOI: 10.1097/meg.0000000000001075] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) has been linked to an increased risk of cardiovascular disease (CVD). To explore the impact of diabetes mellitus (DM) as a cardiovascular risk factor, this meta-analysis quantitatively assessed the association of NAFLD and CVD in diabetic patients. METHODS PubMed, EMBASE, and the Cochrane Library database were analyzed until the end of March 2017. Original studies analyzing the association between NAFLD and cardiovascular risk factors in the diabetic population were included. The available data related to outcome were extracted for the effect estimate using a random-effects model. The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. RESULTS Of the 770 initially identified studies, 11 studies involving 8346 patients were finally included. The Newcastle-Ottawa Quality Assessment Scale scores suggested that the studies included were of high quality. The pooled effects estimate showed that diabetic patients with NAFLD showed a two times increased risk for CVD compared with patients without NAFLD (odds ratio=2.20, 95% confidence interval: 1.67-2.90). Subgroup analysis also yielded a markedly increased risk, with odds ratio (95% confidence interval) values of 2.28 (1.61-3.23) and 1.90 (1.48-2.45) in cross-sectional and cohort studies, respectively. CONCLUSION This is the first meta-analysis investigating the relationship between NAFLD and CVD independent of the impact of DM. Our findings suggested that NAFLD increases the risk of CVD in populations with comparable DM profiles. Diabetic patients diagnosed with NAFLD might benefit from a more early cardiovascular risk assessment, thereby reducing CVD morbidity and mortality.
Collapse
|
8
|
Wu S, Wu F, Ding Y, Hou J, Bi J, Zhang Z. Association of non-alcoholic fatty liver disease with major adverse cardiovascular events: A systematic review and meta-analysis. Sci Rep 2016; 6:33386. [PMID: 27633274 PMCID: PMC5026028 DOI: 10.1038/srep33386] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/24/2016] [Indexed: 12/14/2022] Open
Abstract
Increasing evidence connects non-alcoholic fatty liver disease (NAFLD) to cardiovascular disease (CVD). The aim of this study is to assess whether and to what extent the excess risk of CVD is conferred by NAFLD in a meta-analysis. We systematically searched PubMed, EmBase, Web of Science, and Cochrane Library for reports published between 1965 and July 3, 2015. Studies that reported data on association between NAFLD and adverse cardiovascular events or mortality were included. Thirty-four studies (164,494 participants, 21 cross-sectional studies, and 13 cohort studies) were included. NAFLD was not associated with overall mortality (HR = 1.14, 95% CI: 0.99–1.32) and CVD mortality (HR = 1.10, 95% CI: 0.86–1.41). However, NAFLD was associated with an increased risk of prevalent (OR = 1.81, 95% CI: 1.23–2.66) and incident (HR = 1.37, 95% CI: 1.10–1.72) CVD. For some specific CVDs, NAFLD was associated with an increased risk of prevalent (OR = 1.87, 95% CI: 1.47–2.37) and incident (HR = 2.31, 95% CI: 1.46–3.65) coronary artery disease (CAD), prevalent (OR = 1.24, 95% CI: 1.14–1.36) and incident (HR = 1.16, 95% CI: 1.06–1.27) hypertension, and prevalent (OR = 1.32, 95% CI: 1.07–1.62) atherosclerosis. In conclusion, the presence of NAFLD is associated with an increased risk of major adverse cardiovascular events, although it is not related to mortality from all causes or CVD.
Collapse
Affiliation(s)
- Shunquan Wu
- Research Center for Clinical and Translational Medicine, Beijing 302 Hospital, Beijing, China
| | - Fuquan Wu
- Department of General Surgery, 309th Hospital of PLA, Beijing, China
| | - Yingying Ding
- Department of Medical Microbiology and Parasitology, Second Military Medical University, Shanghai, China
| | - Jun Hou
- Research Center for Clinical and Translational Medicine, Beijing 302 Hospital, Beijing, China
| | - Jingfeng Bi
- Research Center for Clinical and Translational Medicine, Beijing 302 Hospital, Beijing, China
| | - Zheng Zhang
- Research Center for Clinical and Translational Medicine, Beijing 302 Hospital, Beijing, China
| |
Collapse
|
9
|
Cardiovascular Disease and Myocardial Abnormalities in Nonalcoholic Fatty Liver Disease. Dig Dis Sci 2016; 61:1246-67. [PMID: 26809873 DOI: 10.1007/s10620-016-4040-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 01/11/2016] [Indexed: 02/08/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in many developed countries, affecting an estimated 30 % of the adult population. In this updated clinical review, we summarize the current knowledge regarding the strong association between NAFLD and the risk of coronary heart disease (CHD) and other functional, structural, and arrhythmic cardiac complications (e.g., left ventricular dysfunction, heart valve diseases and atrial fibrillation). We also briefly discuss the putative biological mechanisms linking NAFLD with these important extra-hepatic complications. To date, a large body of evidence has suggested that NAFLD is not simply a marker of CHD and other functional, structural, and arrhythmic cardiac complications, but also may play a part in the development and progression of these cardiac complications. The clinical implication of these findings is that patients with NAFLD may benefit from more intensive surveillance and early treatment interventions aimed at decreasing the risk of CHD and other cardiac and arrhythmic complications.
Collapse
|
10
|
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the hepatic component of the metabolic syndrome. The aim of this review is to summarize the available data linking NAFLD with cardiovascular disease (CVD). The following topics are reviewed: (a) the clinical evidence linking NAFLD to increased prevalence of CVD; (b) the relationship between NAFLD (which is diagnosed by liver biopsy, serum liver enzymes, or ultrasonography) and incidence of CVD; (c) the mechanism linking NAFLD to CVD and clinical implication; and (d) the potential impact of NAFLD treatment on cardiac complications. CVD dictates the outcome (or outcomes) in patients with NAFLD more frequently and to a greater extent than does the progression of liver disease. NAFLD patients have a higher risk of all-cause death than the general population, mainly because of CVD or liver-related causes. The biologic mechanism linking NAFLD and CVD might be associated with various factors, involving a complex interaction among insulin resistance, oxidative stress, abnormal adipocytokine profile, endothelial dysfunction, lipid abnormalities, and activation of inflammatory cascade. Lifestyle modifications and pharmacotherapy are helpful to treat patients with NAFLD. NAFLD is likely to be associated with an increased risk of CVD, and raises the possibility that NAFLD may not only be a marker but also an early mediator of CVD.
Collapse
|