Fatty liver, abdominal adipose tissue and atherosclerotic calcification in African Americans: The Jackson Heart Study - ScienceDirect

Atherosclerosis

Volume 224, Issue 2, October 2012, Pages 521-525

Atherosclerosis

https://doi.org/10.1016/j.atherosclerosis.2012.07.042 Get rights and content

Abstract

Objective

Both fatty liver and abdominal visceral fat (VAT) are associated with cardiometabolic risk factors. Whether fatty liver and VAT are jointly associated with coronary artery (CAC) or abdominal aortic (AAC) calcification is not clear.

Methods

Jackson Heart Study (JHS) participants (n = 2884, mean age 60 years, 65% women) underwent non-contrast CT Exam for assessment of fatty liver, VAT, and CAC and AAC. Fatty liver was measured by liver attenuation (LA; low LA = high fatty liver). The Agatston score was used to quantify the amount of calcified artery plaque and the presence of calcified artery plaque was defined as Agatston score>0. Cross-sectional associations of LA and VAT with CAC and AAC were examined in logistic regression models.

Results

LA (per 1-standard deviation [SD] decrement) was associated inversely with CAC in age-sex-adjusted (OR 0.84, 95%CI 0.7–0.9, p = 0.0001) and multivariable-adjusted models (OR 0.89, 95%CI 0.8–0.9, p = 0.01). The association persisted for LA with CAC when additionally adjusted for body mass index (BMI) (OR 0.89, 95%CI 0.8–0.9, p = 0.03) or VAT (OR 0.90, 95%CI 0.8–0.9, p = 0.04). Abdominal VAT (per 1-SD increment) was positively associated with CAC in age-sex-adjusted models (OR 1.27, 95%CI 1.2–1.4, p = 0.0001), but the association was diminished with multivariable adjustment (OR 1.10, 95%CI 0.9–1.2, p = 0.09) and with additional adjustment for LA (p = 0.24) or BMI (p = 0.33). For AAC, the associations with LA and VAT were only present in age-sex-adjusted models. Finally, we did not observe interactions between LA and VAT for CAC (p = 0.18) or AAC (p = 0.24).

Conclusion

Fatty liver is associated with coronary atherosclerotic calcification independent of abdominal VAT or BMI in African Americans. Further investigations to uncover the clinical implications of fatty liver on coronary atherosclerosis in obesity are warranted.

Highlights

► Fatty liver and abdominal visceral fat (VAT) are metabolically connected. ► We examine whether fatty liver is a risk factor for coronary calcification. ► We have found that fatty liver is associated with coronary calcification in African Americans. ► This association is independent of abdominal VAT or body mass index.

Introduction

Artery calcification, measured in coronary artery or abdominal aortic artery, is a measure of subclinical artery disease and a marker of future cardiovascular disease (CVD) above and beyond associations with traditional cardiovascular risk factors [1], [2]. Despite of a lower quantity of VAT and fatty liver found in African Americans [3], [4], our prior work indicates that high levels of both VAT and fatty liver in African Americans from the Jackson Heart Study (JHS) cohort is associated with a high prevalence of cardiometabolic risk factors, including hypertension, diabetes, dyslipidemia and the metabolic syndrome [5], [6]. Based on the strong observed associations between cardiometabolic risk factors and atherosclerosis [7], [8], [9], it is conceivable that individuals with high levels of VAT or fatty liver are at greater risk for coronary artery (CAC) or abdominal aortic calcification (AAC) than those without.

Although abdominal VAT and the liver are metabolically connected, fatty liver is associated with obesity-related cardiometabolic complications independent of abdominal VAT [6], [10]. Increased fatty liver may promote atherosclerotic calcification above and beyond the association of abdominal VAT. Several clinical studies have demonstrated that patients with nonalcoholic fatty liver disease have more severe coronary atherosclerotic burden [11], [12], [13]. However, the association between fatty liver and coronary atherosclerotic burden in these studies is examined without consideration for potential associations with abdominal VAT. In addition, the studies are conducted in small, selected samples, potentially limiting their generalizability. To better understand whether fatty liver is an important correlate of artery atherosclerotic burden above and beyond abdominal VAT, we have comprehensively evaluated the association between fatty liver, abdominal VAT and atherosclerotic burden, measured by CAC or AAC, in participants of the JHS.

Section snippets

Study sample

The original JHS cohort enrolled participants from September 2000 to March 2004 and comprises 5301 participants between the ages of 21–94 years [14]. The present study includes a sub-set of participants (n = 2884) who underwent multi-detector computed tomography (CT) scanning from 2007 to 2009 as a part of the second JHS Examination (JHS Exam 2).

Overall, 4203 participants attended JHS Exam 2 (from 2005 to 2008). Of these, 2884 (65% women) had measurements of abdominal VAT and fatty liver.

Results

Study sample characteristics are presented in Table 1. Overall, the mean age was 59 years and 65% were women; 48% (n = 1386) of study individuals had CAC and 66% (n = 1898) of individuals had AAC. On average, participants with the presence of artery calcification had more adverse risk factor profiles as compared to participants with the absence of artery calcification (Table 1).

Age-sex-adjusted correlation coefficients of log CAC and log AAC with cardiometabolic risk factors are displayed in

Principal findings

Low log LA (i.e. high levels of fatty liver) was associated with CAC. This association persisted after adjustment for traditional CVD risk factors and VAT or BMI. For AAC, the association with log LA or VAT was diminished upon multivariable adjustment. The findings suggest that fatty liver is associated with coronary artery atherosclerotic calcification after accounting for VAT or BMI in African Americans.

In the context of the current literature

Although the association between atherosclerotic calcification and fatty liver has been

Conclusions

Fatty liver is associated with coronary atherosclerotic calcification in African Americans, which is independent of abdominal VAT or BMI. Further investigations to uncover the clinical implications of fatty liver on coronary atherosclerosis in obesity are warranted.

Conflict of interest

All authors disclose no conflict of interest.

Acknowledgments

The Jackson Heart Study is supported by the National Heart, Lung, and Blood Institute and the National Center on Minority Health and Health Disparities. Funding for Dr. Herman A. Taylor was provided under contracts N01-HC-95170, N01-HC-95171 and N01-C-95172 from the National Heart, Lung and Blood Institute and the National Center on Minority Health and Health Disparities.

Also, the authors thank the staff, interns and participants in Jackson Heart Study for their long-term commitment and

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Citation Excerpt :
The Coronary Artery Risk Development in Young Adults (CARDIA) study, which was 50% white, also showed no independent association between NAFLD and CAC or AAC.24 By contrast, the Jackson Heart Study based on an African American cohort reported an independent association between NAFLD and CAC and AAC.18 Further epidemiologic studies to confirm the association between NAFLD and arterial calcification should be performed in diverse study populations.
The association of nonalcoholic fatty liver disease (NAFLD) with systemic calcified atherosclerosis, other than the coronary arteries, has not been clearly elucidated. We investigated the association between NAFLD and calcification in eight different vascular beds.
In a community-based cohort with computed tomography scans for carotid artery, coronary artery, thoracic aorta, abdominal aorta, iliac artery, renal artery, celiac trunk, and superior mesenteric artery, the association between NAFLD and arterial calcification was evaluated with adjustment for age, sex, hypertension, dyslipidemia, diabetes, obesity, current smoking status, and family history of heart disease in the first-degree relatives.
In age- and sex-adjusted models, NAFLD was significantly associated with calcification in the coronary artery, carotid artery, thoracic aorta, celiac trunk, and superior mesenteric artery vascular beds (P < .05). However, adjustment for the traditional chronic venous disease risk factors attenuated the associations, except in the case of the thoracic aorta (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.09-1.78) and celiac trunk (OR, 2.05; 95% CI, 1.16-3.65). In addition, NAFLD was independently associated with multiarterial calcification (four or more [OR, 1.33; 95% CI, 1.01-1.74], five or more [OR, 1.46; 95% CI, 1.09-1.97], and six or more [OR, 1.58; 95% CI, 1.09-2.30] of eight evaluated arterial segments).
The association between NAFLD and arterial calcification is mainly mediated by conventional risk factors. The independent association between NAFLD and calcification in the thoracic aorta and celiac trunk as well as in a larger number of vascular beds needs confirmation in future prospective studies in diverse populations.

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