Association and Prediction of Subclinical Atherosclerosis by Nonalcoholic Fatty Liver Disease in Asymptomatic Patients

Background The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing in the general population. This study evaluated the association between NAFLD and significant coronary stenosis in asymptomatic adults and evaluated sex-based differences. Methods We performed a retrospective cross-sectional study in participants without previous cardiovascular diseases who visited the Seoul National University Hospital Health Promotion Center for a health checkup between January 1, 2010, and December 31, 2015. NAFLD was diagnosed on sonography, while coronary artery stenosis (CAS) was assessed on coronary computed tomography angiography (CCTA). Results We obtained 3,693 participants who met the inclusion criteria, and 3,449 of them had no significant stenosis. Among the participants with significant stenosis, the prevalence of NAFLD was 59.4% (145 patients). The prevalence of NAFLD was 47.26% in male participants, which was higher than that in female participants. The association between NAFLD and significant CAS persisted after adjusting for age, body mass index, glycated hemoglobin, and Framingham risk factors. The correlation between NAFLD and significant coronary stenosis appeared to be stronger in women than in men, but the absolute risk was higher in men than in women. Conclusion NAFLD was strongly associated with CAS. We should be alert about an increased cardiovascular risk in patients with NAFLD and more intensively provide primary prevention by performing tests to detect subclinical atherosclerosis.