Aortic valve sclerosis (AVS) and mitral annulus calcifi cation (MAC) are powerfulpredictors of adverse cardiovascular outcomes in patients with type 2diabetes (T2D), but the aetiology of valvular calcifi cation is uncertain. Nonalcoholicfatty liver disease (NAFLD) is an emerging cardiovascular risk factorcommonly present in T2D patients, but its association with valvular calcifi -cation is unknown. We sought to investigate whether NAFLD is associatedwith AVS and/or MAC in T2D patients. We conducted a cross-sectional studyby performing a conventional echocardiography and liver ultrasonography ina sample of 247 consecutive outpatients with T2D (179 men; mean age 68years) free of known liver diseases, prior history of chronic heart failure andmoderate-to-severe valvular heart disease. Overall, 139 (56.3%) patients hadno calcifi cation at both aortic and mitral valve (HVC-0), 65 (26.3%) had onevalve affected (HVC-1) and 43 (17.4%) patients had both valves affected (HVC-2). NAFLD was present in 175 (70.8%) patients and its prevalence markedlyincreased in patients with HVC-2 compared with either HVC-1 or HVC-0 (86.1%vs. 83.1% vs. 60.4%, respectively; p<0.001). NAFLD was associated with AVSand/or MAC (unadjusted-odds ratio [OR] 3.51, 95% CI 1.89-6.51, p<0.001). Adjustmentsfor age, sex, smoking history, alcohol consumption, diastolic bloodpressure, hemoglobin A1c, LDL-cholesterol, estimated glomerular fi ltrationrate, use of hypoglycemic, lipid-lowering and anti-hypertensive medicationsand echocardiographic variables did not substantially attenuate the strong associationof NAFLD with AVS and/or MAC (adjusted-OR 2.97, 95% CI 1.31-6.70,p<0.01). In conclusion, these results show for the fi rst time that NAFLD is astrong and independent predictor of cardiac calcifi cation in both aortic andmitral valves in patients affected by T2D. Further research is needed to betterelucidate the mechanisms underlying this association.
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