To study the carotid intima media thickness in patients of fatty liver disease

Background: Fatty liver is associated with several atherosclerotic risk factors such as hypertension, diabetes and dyslipidemia. It has also been related to insulin resistance. This association was found in NIDDM patients as well as in non-diabetic subjects. An increased intima-media thickness (IMT) has been shown to be a risk factor for myocardial infarction and stroke. The aim of the present study is to investigate associations between hepatic steatosis and the risk of atherosclerosis.Methods: The present study was carried out on 88 patients of fatty liver disease and 80 controls in the department of General Medicine. An approximate equal number of age and sex matched persons without fatty liver were selected randomly as controls. Both fatty liver disease patients (i.e NAFLD and AFLD) and control group were further divided into two categories, one with risk factor for atherosclerosis and other without risk factors. Risk factors for atherosclerosis were taken according to ATP III guidelines.Results: When comparison of mean CIMT was done in NAFLD, AFLD and controls in a particular age group, significant difference was found in mean CIMT (both sides) in age group 40-49 yrs (p value 0.03, 0.002 for right and left respectively). The difference was also significant in mean CIMT of right in age group 18-24 yrs (p value 0.015) and in >60 years (p value 0.03). Among, NAFLD patients, for left mean CIMT p value was 0.0001, for right mean CIMT p value was 0.0001. Among AFLD patients, for left mean CIMT p value was 0.006 and for right mean CIMT p value was 0.0022. Only statistically significant difference was found in mean CIMT (left) in grade II fatty liver (p value 0.04). NAFLD and controls without risk factors for atherosclerosis, mean CIMT (both side) in NAFLD was found to be significantly more than control (p value 0.04). AFLD patients and controls without risk factors for atherosclerosis, mean CIMT of both side in AFLD patients was found to be significantly more than controls (p value for left CIMT 0.02 and for right CIMT 0.00001).Conclusions: CIMT was found to increase with advancing age in all three group i.e. NAFLD, AFLD and control group. CIMT was more in patients of fatty liver disease (both NAFLD and AFLD) having risk factor for atherosclerosis as compared to those without risk factors. Both NAFLD and AFLD are associated with increased CIMT in comparison to control group. As such all NAFLD and AFLD patients should be investigated for carotid atherosclerosis, as its early detection and management may be helpful in limiting the inherent complications of atherosclerosis.