Non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome, was associated with subclinical atherosclerosis in many cross-sectional studies, but the prospective association between NAFLD and the progression of atherosclerosis has not been evaluated. 

Professor Geum-Youn Gwak and colleagues from South Korea evaluated the association between NAFLD and the progression of coronary atherosclerosis.

The team performed a retrospective cohort study including 4731 adult men and women with no history of cardiovascular disease (CVD), liver disease or cancer at baseline who participated in a repeated regular health screening examination between 2004 and 2013. 

Fatty liver was diagnosed by ultrasound based on standard criteria, including parenchymal brightness, liver-to-kidney contrast, deep beam attenuation and bright vessel walls. 

The researchers measured progression of coronary artery calcium scores using multidetector CT scanners.

The average duration of follow-up was 4 years. 

During follow-up, the team found that the annual rate of coronary artery calcium progression in participants with and without NAFLD were 22%, and 17%, respectively. 

The multivariable ratio of progression rates comparing participants with NAFLD with those without NAFLD was 1.04. 

The researchers observed that the association between NAFLD and coronary artery calcium progression was similar in most subgroups analyzed, including in participants with coronary artery calcium score of 0, and in those with coronary artery calcium score >0 at baseline.

Professor Gwak's team concludes, "In this large cohort study of adult men and women with no history of CVD, NAFLD was significantly associated with the development of coronary artery calcium independent of cardiovascular and metabolic risk factors."

"NAFLD may play a pathophysiological role in atherosclerosis development, and may be useful to identify subjects with a higher risk of subclinical disease progression."