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Original investigation
Non-alcoholic steatohepatitis and progression of carotid atherosclerosis in patients with type 2 diabetes: a Korean cohort study
Yong-ho Lee
Yonsei University College of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6219-4942
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: There is increasing concern regarding cardiovascular risk in individuals with non-alcoholic fatty liver disease. This study was conducted to evaluate whether hepatic steatosis with or without fibrosis is associated with the progression of carotid atherosclerosis in patients with type 2 diabetes.
Methods: From a longitudinal cohort, we enrolled 1,120 patients with type 2 diabetes who underwent repeated carotid artery ultrasonography every 1-2 years. Ultrasonographic findings at baseline and after 6-8 years were compared. Presence of hepatic steatosis was mainly assessed by abdominal ultrasonography; patients with hepatic steatosis were further evaluated for hepatic fibrosis according to fibrosis-4 index. We investigated the association between liver status and atherosclerosis progression.
Results: Of 1,120 patients, 636 (56.8%) were classified as having hepatic steatosis at baseline. After 6-8 years, 431 (38.5%) showed atherosclerosis progression. Hepatic steatosis was significantly associated with atherosclerosis progression (adjusted odds ratio[AOR]: 1.370, 95% CI: 1.025-1.832; p < 0.05). Among patients with hepatic steatosis, only individuals with fibrosis showed significant association with atherosclerosis progression (AOR: 1.615, 95% CI: 1.005-2.598; p < 0.05). The association between hepatic fibrosis and atherosclerosis progression was significant in all metabolic subgroups regardless of age, body mass index, presence of metabolic syndrome, or insulin sensitivity (all p < 0.05). Furthermore, subjects with hepatic steatosis & fibrosis and ≥ 4 components of metabolic syndrome criteria showed markedly increased risk of atherosclerosis progression (AOR: 2.430, 95% CI: 1.087-5.458; p < 0.05).
Conclusions: Hepatic steatosis with fibrosis is independently associated with the progression of carotid atherosclerosis in patients with type 2 diabetes.
Keywords
Atherosclerosis, Hepatic fibrosis, Metabolic syndrome, Non-alcoholic fatty liver disease, Non-alcoholic steatohepatitis, Type 2 diabetes
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On 03 Jun, 2020
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On 02 Jun, 2020
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On 02 Jun, 2020
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Editorial decision: Major Revision
On 15 May, 2020
Review #2 received
Received 14 May, 2020
Review #1 received
Received 05 May, 2020
Reviewer #2 agreed
On 26 Apr, 2020
Reviewer #1 agreed
On 23 Apr, 2020
Reviewers invited
Invitations sent on 22 Apr, 2020
Editor assigned
On 21 Apr, 2020
Submission checks complete
On 20 Apr, 2020
Editor invited
On 20 Apr, 2020
First submitted
On 16 Apr, 2020
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Subject Areas
Endocrinology & Metabolism
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This preprint is under consideration at Cardiovascular Diabetology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Original investigation
Non-alcoholic steatohepatitis and progression of carotid atherosclerosis in patients with type 2 diabetes: a Korean cohort study
Yong-ho Lee
Yonsei University College of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6219-4942
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 2
Posted 08 Jun, 2020
No community comments so far
Editor assigned
On 03 Jun, 2020
Submission checks complete
On 02 Jun, 2020
Editor invited
On 02 Jun, 2020
No comments provided
Editorial decision: Major Revision
On 15 May, 2020
Review #2 received
Received 14 May, 2020
Review #1 received
Received 05 May, 2020
Reviewer #2 agreed
On 26 Apr, 2020
Reviewer #1 agreed
On 23 Apr, 2020
Reviewers invited
Invitations sent on 22 Apr, 2020
Editor assigned
On 21 Apr, 2020
Submission checks complete
On 20 Apr, 2020
Editor invited
On 20 Apr, 2020
First submitted
On 16 Apr, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Endocrinology & Metabolism
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: There is increasing concern regarding cardiovascular risk in individuals with non-alcoholic fatty liver disease. This study was conducted to evaluate whether hepatic steatosis with or without fibrosis is associated with the progression of carotid atherosclerosis in patients with type 2 diabetes.
Methods: From a longitudinal cohort, we enrolled 1,120 patients with type 2 diabetes who underwent repeated carotid artery ultrasonography every 1-2 years. Ultrasonographic findings at baseline and after 6-8 years were compared. Presence of hepatic steatosis was mainly assessed by abdominal ultrasonography; patients with hepatic steatosis were further evaluated for hepatic fibrosis according to fibrosis-4 index. We investigated the association between liver status and atherosclerosis progression.
Results: Of 1,120 patients, 636 (56.8%) were classified as having hepatic steatosis at baseline. After 6-8 years, 431 (38.5%) showed atherosclerosis progression. Hepatic steatosis was significantly associated with atherosclerosis progression (adjusted odds ratio[AOR]: 1.370, 95% CI: 1.025-1.832; p < 0.05). Among patients with hepatic steatosis, only individuals with fibrosis showed significant association with atherosclerosis progression (AOR: 1.615, 95% CI: 1.005-2.598; p < 0.05). The association between hepatic fibrosis and atherosclerosis progression was significant in all metabolic subgroups regardless of age, body mass index, presence of metabolic syndrome, or insulin sensitivity (all p < 0.05). Furthermore, subjects with hepatic steatosis & fibrosis and ≥ 4 components of metabolic syndrome criteria showed markedly increased risk of atherosclerosis progression (AOR: 2.430, 95% CI: 1.087-5.458; p < 0.05).
Conclusions: Hepatic steatosis with fibrosis is independently associated with the progression of carotid atherosclerosis in patients with type 2 diabetes.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5