Abstract
Background/Aims
Non-alcoholic fatty liver disease (NAFLD) is closely associated with abdominal obesity, dyslipidemia, hypertension, and Type 2 diabetes, which are all features of the metabolic syndrome. The aim of the present study was to elucidate whether NAFLD is associated with carotid atherosclerosis. Methods: The study population comprised 659 subjects without hepatitis B and C infections and who did not consume alcohol. Fatty infiltrations of liver were detected by abdominal ultrasonography, and intima-media thickness (IMT) and plaque prevalence were estimated by carotid ultrasonography. Results: The mean values of systolic and diastolic pressures, body mass index (BMI), aspartate aminotransferase, alanine aminotransferase, gamma- glutamyl transpeptidase, uric acid, total cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol, fasting glucose, fasting insulin, homeostasis model of assessment (HOMA) index, hemoglobin A1c, and plasminogen activator inhibitor-1 differed significantly between patients with NAFLD (n=314) and normal controls (n=345). The carotid IMT was 0.817±0.212 (mean±SD) mm in patients with NAFLD and 0.757±0.198 mm in normal controls (p<0.001). The prevalence of carotid plaques was higher in patients with NAFLD (26.4%) than in normal controls (15.9%) (p<0.001). This association persisted significantly after adjusting for age, sex, BMI, HOMA index and individual factors of metabolic syndrome by multiple logistic regression analysis. Conclusions: Patients with NAFLD are at a high risk of carotid atherosclerosis regardless of metabolic syndrome and classical cardiovascular risk factors. Therefore, the detection of NAFLD should alert to the existence of an increased cardiovascular risk. Moreover, NAFLD might be an independent risk factor for cardiovascular disease. (Korean J Hepatol 2008;14:77-88)
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- Non-alcoholic fatty liver disease (NAFLD) and its association to cardiovascular disease: A comprehensive meta-analysis
Irina Lubomirova Mladenova, Eu Fon Tan, Jing Yong Ng, Pankaj Sharma
JRSM Cardiovascular Disease.2025;[Epub] CrossRef - Associations between MASLD phenotypes and the risk of carotid artery plaque: a cross-sectional study among railway workers
Jia Pan, Honglian Zeng, Yongyan Song, Xiaoli Zhang, Zihang Wang, Lei Tang, Bo Xie, Rong Peng, Yuanyuan Zhou, Beizhong Liu
Acta Diabetologica.2025; 62(12): 2085. CrossRef - Development of an Educational Model for a Vascular Insertion Device System
Chan-Woo Park, Pyong-Kon Cho
Journal of Radiological Science and Technology.2025; 48(4): 385. CrossRef - Conventional ultrasound for diagnosis of hepatic steatosis is better than believed
Christoph F. Dietrich, Long Shi, Axel Löwe, Yi Dong, Andrej Potthoff, Zeno Sparchez, Andreas Teufel, Sabine Guth, Jonas Koch, Richard G Barr, Xin-Wu Cui
Zeitschrift für Gastroenterologie.2022; 60(08): 1235. CrossRef - Relationship between Nonalcoholic Fatty Liver Disease and High Sensitivity C-Reactive Protein in Healthy Adults
Yunhyoung Choi, Jung-Eun Oh, Jin Lee, Hwang-Sik Shin, Yong-Jin Cho, Sun-Hee Kim, Hyun Joe, Byung-Wook Yoo, Sung-Ho Hong, Choo-Yon Cho, Doo-Yong Son, Kyung-Suk Shin
Korean Journal of Family Practice.2021; 11(1): 39. CrossRef - A practical means of evaluating the prognosis of acute pancreatitis : measurement of carotid artery intima-media thickness
K Kurkcu, B Kara, A.S. Koc, S.O. Keskek
Acta Gastro Enterologica Belgica.2021; 84(3): 437. CrossRef - Association of Cardiovascular Risk Factors and Metabolic Syndrome with non-alcoholic and alcoholic fatty liver disease: a retrospective analysis
A. L. Han
BMC Endocrine Disorders.2021;[Epub] CrossRef - Liver transplantation and cardiac illness: Current evidences and future directions
Ajay Kumar Jha, Suman Lata
Journal of Hepato-Biliary-Pancreatic Sciences.2020; 27(5): 225. CrossRef - Association between cagA negative Helicobacter pylori status and nonalcoholic fatty liver disease among adults in the United States
Seung Joo Kang, Hwa Jung Kim, Donghee Kim, Aijaz Ahmed, Silvia C. Sookoian
PLOS ONE.2018; 13(8): e0202325. CrossRef - Reactive hyperemia index can screen endothelial dysfunction in obese subjects with non-alcoholic fatty liver disease
Shozo Yano, Hiroshi Tobita, Chikako Watano, Seiji Mishima, Yutaka Ishibashi, Abdullah M. Sheikh, Atsushi Nagai
Vascular Failure.2018; 2(1): 39. CrossRef - Managing diabetes and liver disease association
Abd Elkhalek Hamed, Medhat Elsahar, Nadia M. Elwan, Sarah El-Nakeep, Mervat Naguib, Hanan Hamed Soliman, Ashraf Ahmed Aboubakr, Amany AbdelMaqsod, Heba Sedrak, Samir N. Assaad, Reda Elwakil, Gamal Esmat, Samira Salh, Taymour Mostafa, Sherif Mogawer, Sameh
Arab Journal of Gastroenterology.2018; 19(4): 166. CrossRef - Serum Alanine Aminotransferase Levels within Normal Range Have Different Associations with Augmentation Index and Other Cardiometabolic Risk Factors in Nondrinkers and Drinkers: A Chinese Community-Based Analysis
Shihui Fu, Chunling Liu, Leiming Luo, Ping Ye
Gastroenterology Research and Practice.2017; 2017: 1. CrossRef - The relationship of serum alanine aminotransferase normal-range levels to arterial stiffness and metabolic syndrome in non-drinkers and drinkers: a Chinese community-based analysis
Shihui Fu, Ying Lin, Leiming Luo, Ping Ye
BMC Gastroenterology.2017;[Epub] CrossRef - Arterial stiffness in metabolic syndrome
Mona Adel, Ayman ELSheikh, Sameh Sameer, Waiel Haseeb, Eman ELSheikh, Lamia Kheder
Journal of the Saudi Heart Association.2016; 28(4): 249. CrossRef - Prevalence of nonalcoholic fatty liver disease in outpatients in Rostov-on-Don: Regional results of the DIREG-2 study
A V Tkachev, G N Tarasova, V S Groshilin, D A Vasilchenkov, T I Ushakova, D V Blinov
Terapevticheskii arkhiv.2016; 88(8): 59. CrossRef - Long-Term Outcomes of Nonalcoholic Fatty Liver Disease
Min-Sun Kwak, Donghee Kim
Current Hepatology Reports.2015; 14(2): 69. CrossRef - Nonalcoholic fatty liver disease and carotid artery atherosclerosis in children and adults
Shivank A. Madan, Febin John, Nikolaos Pyrsopoulos, Capecomorin S. Pitchumoni
European Journal of Gastroenterology & Hepatology.2015; 27(11): 1237. CrossRef - Nonalcoholic Fatty Liver Disease as a Risk Factor of Arterial Stiffness Measured by the Cardioankle Vascular Index
Goh Eun Chung, Su-Yeon Choi, Donghee Kim, Min-Sun Kwak, Hyo Eun Park, Min-Kyung Kim, Jeong Yoon Yim
Medicine.2015; 94(12): e654. CrossRef - Central obesity and nonalcoholic fatty liver disease risk after adjusting for body mass index
Qing Pang
World Journal of Gastroenterology.2015; 21(5): 1650. CrossRef - Relationship of Colorectal Polyps and Fatty Liver Disease Diagnosed by Ultrasonography
Hye-Nam Lee, Cheong-Hwan Lim, Hong-Ryang Jung
Journal of Digital Convergence.2014; 12(3): 345. CrossRef - The Intima Media Thickness (IMT) as Measured by Carotid Ultrasonography in Patients with Retinal Vascular Diseases
Sang Jin Seo, Hyun Duk Jang, Soo Jung Lee, Jung Min Park
Journal of the Korean Ophthalmological Society.2014; 55(4): 541. CrossRef - Noninvasive markers: a double-edged sword that stratifies nonalcoholic steatohepatitis
Goh Eun Chung, Donghee Kim
Clinical and Molecular Hepatology.2013; 19(2): 116. CrossRef - Independent Association between Nonalcoholic Fatty Liver Disease and Cardiovascular Disease: A Systematic Review and Meta-Analysis
Hongyun Lu, Hong Liu, Fang Hu, Lingling Zou, Shunkui Luo, Liao Sun
International Journal of Endocrinology.2013; 2013: 1. CrossRef - Improvement of metabolic syndrome by irbesartan via the PPARγ/HGF pathway in apolipoprotein E knockout mice
AMARNATH CHATTERJEE, HIROSHI KUSUNOKI, YOSHIAKI TANIYAMA, HIROMI RAKUGI, RYUICHI MORISHITA
Biomedical Reports.2013; 1(1): 65. CrossRef - Non-alcoholic fatty liver disease across the spectrum of hypothyroidism
Goh Eun Chung, Donghee Kim, Won Kim, Jeong Yoon Yim, Min Jung Park, Yoon Jun Kim, Jung-Hwan Yoon, Hyo-Suk Lee
Journal of Hepatology.2012; 57(1): 150. CrossRef - Which metabolic syndrome criteria best predict the presence of non-alcoholic fatty liver disease?
Hyun Il Seo, Yong Kyun Cho, Won Young Lee, Eun Jung Rhee, Ki Chul Sung, Bum Soo Kim, Byung Ho Son, Jun Ho Shin, Kwan Joong Joo, Hyun Pyo Hong, Seoung Wan Chae, Wook Jin
Diabetes Research and Clinical Practice.2012; 95(1): 19. CrossRef - Relationship between Nonalcoholic Fatty Liver Disease and Carotid Artery Atherosclerosis Beyond Metabolic Disorders in Non-Diabetic Patients
Ji Hoon Kang, Kyoung Im Cho, Seong Man Kim, Ja Young Lee, Jae Joon Kim, Ja Jun Goo, Kyoung Nyoun Kim, Joon Hyung Jhi, Dong Jun Kim, Hyeon Gook Lee, Tae Ik Kim
Journal of Cardiovascular Ultrasound.2012; 20(3): 126. CrossRef - Nonalcoholic fatty liver disease is associated with coronary artery calcification
Donghee Kim, Su-Yeon Choi, Eun Ha Park, Whal Lee, Jin Hwa Kang, Won Kim, Yoon Jun Kim, Jung-Hwan Yoon, Sook Hyang Jeong, Dong Ho Lee, Hyo-suk Lee, Joseph Larson, Terry M. Therneau, Ray W. Kim
Hepatology.2012; 56(2): 605. CrossRef - Carotid Intima-Media Thickness Is Increased Not Only in Non-Alcoholic Fatty Liver Disease Patients but Also in Alcoholic Fatty Liver Patients
Jeong Han Kim, Seung Young Kim, Eun Seok Jung, Sung Woo Jung, Ja Seol Koo, Ji Hoon Kim, Jong Eun Yeon, So Young Kwon, Sang Woo Lee, Kwan Soo Byun, Chang Hong Lee
Digestion.2011; 84(2): 149. CrossRef - Association between nonalcoholic fatty liver disease and carotid intima-media thickness according to the presence of metabolic syndrome
Hyeon Chang Kim, Dae Jung Kim, Kap Bum Huh
Atherosclerosis.2009; 204(2): 521. CrossRef - The Relation Between Non-Alcoholic Fatty Liver Disease and the Risk of Coronary Heart Disease in Koreans
Su-Yeon Choi, Donghee Kim, Hwa Jung Kim, Jin Hwa Kang, Su Jin Chung, Min Jung Park, Young Sun Kim, Chung Hyun Kim, Seung Ho Choi, Won Kim, Yoon Jun Kim, Jung-Hwan Yoon, Hyo-Suk Lee, Sang-Heon Cho, Myung-Whun Sung, Byung-Hee Oh
The American Journal of Gastroenterology.2009; 104(8): 1953. CrossRef - Carotid lesions in outpatients with nonalcoholic fatty liver disease
Stefano Ramilli, Stefano Pretolani, Antonio Muscari, Barbara Pacelli, Vincenzo Arienti
World Journal of Gastroenterology.2009; 15(38): 4770. CrossRef - Nonalcoholic fatty liver disease as a risk factor of cardiovascular disease
Moon Young Kim, Soon Koo Baik
The Korean Journal of Hepatology.2008; 14(1): 1. CrossRef