Noninvasive liver fibrosis markers are independently associated with carotid atherosclerosis risk in patients with nonalcoholic fatty liver disease

Abstract

Objective

Nonalcoholic fatty liver disease (NAFLD) is considered an independent risk factor for cardiovascular disease (CVD). The overall morbidity and mortality of CVD increase with higher fibrosis stage in NAFLD. Carotid atherosclerosis (CAS) is an important predictor of cardiovascular events. However, the relationship between liver fibrosis degree and the risk of CAS in NAFLD patients remains uncertain. We aimed to investigate the relationship between noninvasive liver fibrosis markers and CAS risk in patients with NAFLD.

Materials and Methods

This study included 3,302 participants with NAFLD. Participants were divided into a CAS group and a non-CAS group based on carotid artery ultrasound results. They were then stratified into quartiles using various noninvasive liver fibrosis markers (fibrosis-4 (FIB-4), modified FIB-4 (mFIB-4), aminotransferase to platelet ratio index (APRI), aminotransferase to alanine aminotransferase ratio (AAR), AAR-to-platelet ratio index (AARPRI), and Forns index) to assess the associations between these markers and the risk of CAS.

Results

In the NAFLD population, individuals with CAS exhibited elevated levels of blood pressure, glucose, lipids, and noninvasive liver fibrosis markers (p < 0.001). The higher quartiles of noninvasive liver fibrosis markers, including FIB-4, mFIB-4, AAR, AARPRI, and Forns index, were significantly associated with increased risks of CAS, even after adjusting for multiple CVD risk factors.

Conclusions

In individuals with NAFLD, increased noninvasive liver fibrosis markers were independently associated with elevated CAS risk, which may be beneficial in assessing the risk of CVD in individuals with NAFLD.

Keywords:

• Nonalcoholic fatty liver disease
• carotid atherosclerosis
• cardiovascular disease
• noninvasive liver fibrosis marker
• cardiovascular disease risk

Acknowledgments

Not applicable.

Authors’ contributions

JS and LZ analyzed the data, drafted the manuscript, and revised the manuscript. JL interpreted the results. YW was responsible for recruiting subjects, collecting data, and revising the manuscript. GW contributed to the study design, and data interpretation and reviewed the manuscript. All authors read and approved the final version of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

We gratefully acknowledge the financial support from the National Key Research and Development Program of China (2022YFA0806400) and the Clinical Research Incubation Project of Beijing Chao-Yang Hospital, Capital Medical University (CYFH202304).