Association between Nonalcoholic Fatty Liver Disease Based on Ultrasonography Indices and Severity of Coronary Artery Disease: A Cross-Sectional Study

Recent observations highlighted the importance of evaluating nonalcoholic fatty liver disease (NAFLD) in individuals with coronary artery disease (CAD) to establish strategies to prevent the evolution of the disease. However, the association between severity of CAD and NAFLD remains uncertain. The aim of this study was to investigate whether NAFLD was associated with severity of CAD assessed by coronary angiography.

This cross-sectional study was performed on 320 consecutive patients who were candidates for coronary angiography. All patients underwent coronary angiography to assess the presence and severity of coronary involvement and liver ultrasonography to assess the degree of fatty liver in the same session. The extension of CAD was measured using the Gensini score. The severity of NAFLD was measured using ultrasonography grading (Grade 0- III).

Regarding grade of NAFLD, 42.2% of patients had normal condition (Grade 0), 31.5% had grade I, 19.7% had grade II, and 6.6% had grade III of NAFLD. With regard to the difference in grading of NAFLD between cardiovascular risk subgroups, this difference was only observed between the patients with BMI ≥ 30 kg/m2 and those with BMI < 30 kg/m2. The mean Gensini score in patients with normal condition (Grade 0) or grade I of NAFLD was 20.6 ± 1.2, in grade II of NAFLD was 23.6 ± 4.2, and in those with grade III of NAFLD was 47.3 ± 9.6. Findings indicate that CAD severity increases with the increase in the grade of NAFLD (p = 0.002). Using the multivariate linear regression model and with the presence of baseline variables as the confounders, the association between the Gensini score and NAFLD grade remained significant (p = 0.001).

The present study demonstrates a higher Gensini score in those patients with higher grades of NAFLD indicating a linear association between CAD severity and severity of NAFLD.