Nafld As A Cardiovascular Risk Factor

Data is emerging that NAFLD is an independent risk factor for vascular disease, which is the most common cause of death among patients with diabetes (1). Patients with NAFLD have a greater carotid intima-media thickness as well as a higher prevalence of carotid atheromatous plaques (51). The presence of NAFLD among patients with type 2 diabetes is associated with an increased risk of developing vascular disease, which is only partly associated with the presence of the metabolic syndrome (52,53). Similarly, ALT is independently predictive of the development of coronary heart disease (54). The mechanisms through which NAFLD may result in increased vascular disease are unclear and it is difficult to distinguish whether this is an association with the abnormal metabolic milieu that occurs in association with NAFLD or whether it is related to the increased lipid oxidation, inflammation and abnormal hepatic lipid metabolism that occurs with NAFLD. Certainly, lipid profiles among diabetics with NAFLD are more atherogenic with lower HDL-cholesterol levels and higher levels of small LDL cholesterol (55). In addition, hepatic steatosis in diabetics is associated with myocardial insulin resistance and lower coronary flow reserve, which increases susceptibility to myocardial injury (56).

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