Subclinical and clinical atherosclerosis in Non-alcoholic Fatty Liver Disease is associated with the presence of hypertension

Background and aims Non-alcoholic fatty liver disease (NAFLD) is associated with increased cardiovascular risk. However, whether NAFLD contributes independently to the development of cardiovascular disease is not fully understood. Our study aimed at assessing the differences in several indices of atherosclerosis, arterial stiffness and cardiac morphology among patients with isolated NAFLD, isolated hypertension (HT) or with combination of the two conditions. Methods and results One hundred and sixty-nine participants (mean age=50.4±10.2 yrs; males=73.6 %) were divided according to the presence of NAFLD and HT in three groups: only-NAFLD (55 patients), only-HT (49 patients) and NAFLD+HT (65 patients). Exclusion criteria were BMI≥35Kg/m2 and presence of diabetes mellitus. Carotid ultrasonography was performed to measure markers of atherosclerosis and arterial stiffness. Cardiac remodeling was analyzed using echocardiography. Prevalence of subclinical and overt atherosclerosis was significantly higher in the NAFLD+HT patients as compared to the other two groups (atherosclerotic plaques: 43.1%, 10.9%, 22.4% (p<0.001), in NAFLD+HT, NAFLD and HT groups). No differences were found among indices of arterial stiffening and cardiac remodeling across the three groups. In multivariate regression analysis the coexistence of NAFLD and HT was an independent risk factor for overt atherosclerosis (OR=4.88; p=0.03), while no association was found when either NAFLD or HT was considered alone. Conclusion Overt atherosclerosis was significantly present only in NAFLD+HT patients, but not in patients presenting with isolated NAFLD. This implies that the impact of NAFLD on vascular structure and function could depend on the coexistence of other major cardiovascular risk factors, such as HT.