Association of coronary artery calcification with hepatic steatosis in asymptomatic individuals

Abstract

Objective: To determine the association of coronary artery calcification with hepatic steatosis in asymptomatic volunteers.

Patients and methods: The study group comprised 400 asymptomatic volunteers, enrolled from April 1, 2011, to September 30, 2012, without known coronary artery disease who were self-referred for screening noncontrast computed tomography to determine coronary calcium score (CCS). Computed tomographic images were used to determine the presence of hepatic steatosis. An a priori model was created to predict a CCS of 100 Agatston units (AU) or higher on the basis of Framingham risk factors, diabetes mellitus, and metabolic syndrome. Hepatic steatosis was then added to this model. Computation of the odds ratio (OR) for hepatic steatosis predicting a CCS of 100 AU or higher was performed. Finally, the OR for a CCS of 100 AU or higher being associated with hepatic steatosis was calculated.

Results: When hepatic steatosis was added to traditional coronary risk factors, it was independently associated with a CCS of 100 AU or higher (OR, 2.85). This was greater than the OR of Framingham factors, diabetes mellitus, or metabolic syndrome. A CCS of 100 AU or higher was independently associated with an increased risk for hepatic steatosis (OR, 2.4). This OR was higher than traditional hepatic steatosis risk factors or metabolic syndrome.

Conclusion: Hepatic steatosis is a strong independent predictor of a CCS of 100 AU or higher in asymptomatic patients. It is associated with an increased risk of coronary artery disease beyond that expected from traditional coronary risk factors and/or metabolic syndrome. Additional studies are needed to clarify the role of hepatic steatosis as a possible independent risk factor for the development of coronary artery disease.

Keywords: AU; Agatston units; BMI; CAC; CAD; CCS; CT; DM; IDI; LDL-C; NAFLD; OR; body mass index; computed tomography; coronary artery calcium; coronary artery disease; coronary calcium score; diabetes mellitus; integrated discrimination improvement; low-density lipoprotein cholesterol; nonalcoholic fatty liver disease; odds ratio.