Correlation Between Metabolic Associated Fatty Liver Disease And Carotid Atherosclerosis

Objective(s): To analyze the correlation between metabolic associated fatty liver disease(MAFLD)and carotid atherosclerosis(AS),and the effect of MAFLD on carotid plaque and carotid stenosis.Methods: Patients who underwent simultaneous abdominal ultrasound and carotid vascular ultrasound during hospitalization in the Department of Gastroenterology,the Second Affiliated Hospital of Kunming Medical University from 2014-01-01 to2020-06-30 were included.Baseline data and clinical diagnosis of all patients were recorded,and the patients were divided into the MAFLD and non-MAFLD groups according to medical history,clinical tests and imaging indexes.Compared the general data of the two groups,such as gender,age,smoking,height,weight,body mass index(BMI),history of taking lipid-lowering drugs,hypertension or medication history and type 2 diabetes history.Compared the laboratory indicators of the two groups,such as triglyceride(TG),high-density lipoprotein(HDL),pre-diabetes diagnostic indicators [fasting blood glucose(FPG),2h postprandial blood glucose,glycosylated hemoglobin(Hb A1C)],alanine transaminase(ALT),aspartate transaminase(AST).According to the echo intensity,carotid atherosclerotic plaque is divided into four types: strong echogenicity,isoechogenicity,hypoechogenicity,and mixed echogenicity.According to the degree of stenosis,the carotid artery is divided into normal vessels,stenosis<50%,and stenosis ≥ 50%.Quantitative data conforming to normal distribution were expressed as mean ± standard deviation,and t-test was used.Quantitative data not conforming to normal distribution were expressed as median(P25,P75),and non-parametric test was used.Qualitative data were expressed as frequency(percentage),and chi-square test was used.The relationship between MAFLD and carotid plaque was analyzed by univariate and multifactorial logistic regression.P < 0.05 was considered to be statistically significant.Results:1.A total of 991 patients were included in this study,including 536 in the MAFLD group and 455 in the non-MAFLD group.The average age of patients in MAFLD group is relatively small,the proportion of males is slightly higher than that of females,and the proportion of smokers is higher.Compared with the non-MAFLD group,the MAFLD group had higher BMI,SBP,DBP,ALT,AST and TG,while HDL was lower than the non-MAFLD group.The proportion of patients with insulin resistance,pre-diabetes,hypertension or medication history,type 2 diabetes history,long-term use of antihypertensive drugs or lipid-lowering drugs was higher than that of patients without MAFLD(P<0.05).2.The proportion of patients with carotid atherosclerosis in MAFLD group was higher than that in non-MAFLD group(87.50% vs 80.43%,P=0.002);3.754 of 991 patients had carotid plaque,and the proportion of hypoechogenicity plaque in MAFLD group was higher than that in non-MAFLD group(37.62% vs27.78%,P=0.004).The results of univariate logistic regression analysis showed that there was a positive correlation between MAFLD and vulnerable carotid plaques [OR(95% CI)=1.568(1.151,2.137),P=0.004].After adjusting for gender,age,smoking,TG,hypertension or medicaton history,type 2 diabetes history,ALT,multivariate logistic regression analysis suggested that MAFLD was an independent risk factor for the formation of carotid hypoechogenicity plaques [OR(95% CI)=1.639(1.149,2.338),P=0.006].4.Among 754 patients with carotid plaque,the proportion of mixed echogenicity plaque in MAFLD group was higher than that in non-MAFLD group(31.07% vs23.10%,P=0.015).Univariate logistic regression analysis showed that there was also a positive correlation between MAFLD and carotid mixed echogenicity plaques [OR(95% CI)=1.500(1.082,2.080),P=0.015].Similarly,after adjusting for gender,age,smoking,TG,hypertension or medicaton history,type 2 diabetes history,and ALT,multivariate logistic regression analysis suggested that MAFLD was an independent risk factor for the formation of carotid mixed echogenicity plaque [OR(95%CI)=1.633(1.120.2.381),P=0.011].5.The proportion of patients with carotid artery stenosis(≥50%)in MAFLD group was higher than that in non-MAFLD group(9.33% vs 4.18%,P=0.001).6.Univariate logistic regression analysis showed that there was a positive correlation between MAFLD and carotid artery stenosis(≥ 50%)[OR(95% CI)=2.361(1.371,4.067),P=0.002];After adjusting for gender,smoking,HDL,BMI,hypertension or medication history,type 2 diabetes history,and AST,multivariate logistic regression analysis showed that MAFLD was an independent risk factor for carotid stenosis(≥50%)[OR(95% CI)=1.983(1.067,3.682),P=0.030].Conclusion(s):1.The prevalence of carotid atherosclerosis in MAFLD patients is high.2.The incidence of carotid hypoechogenicity plaque and mixed echogenicity plaque in patients with MAFLD is high.3.Male,smoking history,MAFLD,higher BMI,TG,HDL,ALT,AST,SBP,insulin resistance,history of type 2 diabetes,hypertension or medication history and history of taking lipid-lowering drugs are risk factors for the formation of carotid hypoechogenicity plaque and mixed echogenicity plaque of carotid artery.MAFLD was an independent risk factor for the formation of carotid hypoechogenicity and mixed echogenicity plaque.4.The incidence of carotid artery stenosis(≥50%)in MAFLD patients is high.5.Male,smoking history,MAFLD,higher BMI,TG,HDL,AST,SBP,insulin resistance,history of type 2 diabetes,hypertension or medication history and history of taking lipid-lowering drugs are all risk factors for carotid artery stenosis(≥50%).MAFLD was an independent risk factor for carotid stenosis(≥50%).