Association of nonalcoholic fatty liver disease with coronary artery calcification progression: a systematic review

Type of funding sources: None.

Several studies have demonstrated the association of coronary artery calcification (CAC)  with non alcoholic fatty liver disease(NAFLD). The aim of this systematic review is to assess the association of NAFLD with the progression of subclinical atherosclerosis, reflected as the dynamic changes in CAC score(CACs) over time.

Electronic and manual searches retrieved 578 potentially relevant publications. The initial screening resulted in removing 486 papers according to title and abstract.  By reviewing the full articles, 53 papers were further excluded and eventually, 5 studies were included in this review.

Four studies were from South Korea, while one study was from USA. 

VanWagner et al(1) showed that NAFLD participants had increased prevalence of CAC progression compared to those without NAFLD, 37.9% vs. 26.0% respectively, p < 0.001.

Sung et al(2) showed that in 592 (27.2%) participants, CACs increased from baseline; while in the rest 1583 subjects, CACs did not change or improved during follow-up, p < 0.001.

Park et al(3) noticed that more subjects with NAFLD than without showed CAC progression(48.8% vs. 38.4% respectively;p < 0.001. But in subjects without calcification at baseline, NAFLD significantly affected the development of calcification after adjusting for traditional metabolic risk factors. However, in subjects with baseline CAC, NAFLD did not affect progression.

Sinn et al(4) found that the annual rate of CAC progression in subjects with and without NAFLD were 22% and 17% respectively, p < 0.001. The association between NAFLD and CAC progression was observed both in subjects with CACs = 0 and in those with CACs > 0 at baseline.

In the study by Cho et al(5) CAC progression was seen in 28.3% of subjects with NALFD, and in 18.6% of subjects in the control group.

 In our review, we found that NAFLD is associated with the progression of subclinical atherosclerosis as it was expressed by the CAC.