Objective: To study the relationship between non-alcoholic steatohepatitis (NASH) and atherosclerosis in young and middle-aged patients, and to provide clinical evidence that will aid in prevention and prediction of development of atherosclerosis or cardiovascular diseases in patients with non-alcoholic fatty liver disease (NAFLD).
Methods: Fifty-one patients with biopsy-proven NAFLD (18 to 60 years in age) were divided into two groups: cases with simple non-alcoholic fatty liver (NAFL, n = 11) and cases with NASH (n = 40). All subjects underwent physical examination and anthropometric measurements. Fasting serum was assayed by blood biochemistry. Insulin resistance was estimated by the homeostatic model assessment index (HOMA-IR). Serum levels of high-sensitivity C-reactive protein (hs-CRP), soluble intercellular adhesion molecule-1 (sICAM-1), and endothelin-1 (ET-1) were detected by enzyme-linked immunosorbent assay. Carotid intima-media thickness (CIMT) was estimated by carotid ultrasound. Brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index were estimated using a volume-plethysmographic apparatus. Data for the two groups were summarized as mean +/- SD or interquartile range and intergroup differences were evaluated by paired t-test or Wilcoxon test, with two-sided P-values less than 0.05 indicating significance.
Results: The serum levels of hs-CRP, sICAM-1, and ET-1 were significantly higher in the NASH group than the NAFL group (all P less than 0.001). In addition, the CIMT and baPWV were significantly higher in the NASH group than the NAFL group (both P less than 0.05). The HOMA-IR was also significantly higher in the NASH group than the NAFL group (P less than 0.001).
Conclusion: Liver inflammation and insulin resistance may play important, and possibly collaborative, roles in promoting arterial endothelial dysfunction and atherosclerosis in NAFLD patients. NASH patients, especially those who are young and middle-aged, may benefit from early monitoring and prevention strategies to help decrease the risk of developing severe cardiovascular diseases.