The Study On The Relationship Between NAFLD And Coronary Artery Vulnerable Plaque And Their Prognosis

Objective:To investigate the relationship between NAFLD and coronary artery vulnerable plaque and their prognosis.Method:1556 consecutive patients were included who had undergone coronary artery CT angiography(CCTA)from January 1,2011 to January 30,2015 at the first people's Hospital in Neijiang.Baseline data,clinical diagnosis and coronary artery stenosis score were recorded.The vulnerable plaques were identified and their stenosis score were recorded.The subjects were followed up.NAFLD was diagnosed according to the liver imaging findings(liver/spleen CT ratio<1.0)and clinical data.The end points of the study were all-cause death,cardiac death,non-fatal myocardial infarction,and elective coronary revascularization.The composite cardiovascular adverse events endpoints included the above 4 endpoints.Result:Baseline data:Excluding 487 patients who did not meet the requirements,this study eventually included 1069 patients,316 cases of NAFLD(29.6%)and 753 cases of non-NAFLD(70.4%).The average age of the study was 65.5111.5 years(39-87 years),the average age of the NAFLD group was 66.1±11.7 years,and the non-NAFLD group was 65.3±11.4 years,there was no significant difference between the two groups(P=0.313).The proportion of female in NAFLD group was significantly lower than that in non-NAFLD group(35.1%vs 42.6%,P=0.024).The levels of GGT and TG in NAFLD group were significantly higher than those in non-NAFLD group(39.1±50.4 U/L vs 32.7±46.6 U/L,P=047;1.7±1.4 mmol/L vs 1.5±0.9 mmol/L,P=0.044).The average HDL-C in NAFLD group was 1.2±0.4 mmol/L,and that in non-NAFLD group was 1.3±0.4 mmol/L,the former was significantly lower than the latter(P=0.003).The proportion of acute coronary syndrome in group NAFLD was significantly higher than that in non-NAFLD group(24.1%vs 17.3%,P=0.014).The proportion of oral statins and antihypertensive medicine in NAFLD group was significantly higher than that in non-NAFLD group(63.3%vs 56.4%,P=0.041;57.0%vs 48.8%,P=0.016).There were no significant differences in smoking,family history of coronary heart disease,type 2 diabetes mellitus,dyslipidemia,CKD-5,hypertension,hypoglycemic drugs and antiplatelet drugs between the two groups.NAFLD and Vulnerable Plaques in Coronary Artery:Of the 1069 patients,347(32.5%)had vulnerable plaques,81(7.6%)had 2-3 vulnerable plaques on coronary CTA image.Among 316 cases of NAFLD,130 cases(41.1%)had vulnerable plaques and 39 cases(12.3%)had more than 2 vulnerable plaques.Of 753 non-NAFLD patients,217(28.8%)had vulnerable plaques and 42(5.6%)had more than or equal to 2 vulnerable plaques.The proportion of vulnerable plaques and multiple vulnerable plaques in NAFLD group were significantly higher than those in non-NAFLD group(P<0.001,P=0.011,respectively).The percentages of spotty calcification,low attenuation plaque,positive remodeling and napkin ring sign in NAFLD group were 36.5%,14.2%,17.6%and 6.8%respectively,while those in non-NAFLD group were 18.4%,6.3%,5.8%and 3.2%respectively.The percentages of these four vulnerable features in NAFLD group were significantly higher than those in non-NAFLD group,with P values of 0.016,0.028,0.019 and 0.042,respectively.Obstructive plaques(stenosis>50%)accounted for 52.7%in 347 patients with vulnerable plaques.Among NAFLD patients,27.8%had obstructive vulnerable plaques,and 12.6%among non-NAFLD patients.The former was significantly higher than the latter(P<0.001).Univariate logistic regression analysis showed that NAFLD was a risk factor for vulnerable plaque(OR=1.73,P<0.001).In multivariate logistic regression analysis,two models were used to correct the risk factors,suggesting that NAFLD was still a risk factor for vulnerable plaque of coronary artery(OR were 1.57 and 1.63 respectively;P values were 0.002 and 0.003 respectively).Relationship between NAFLD and Coronary Atherosclerotic Heart Disease:Of the 1069 patients,391(36.6%)had no plaque on coronary CTA and 678(63.4%)had coronary atherosclerosis(defined as any plaque on the CCTA).The proportion of NAFLD was 31.0%in atherosclerosis patients and 27.6%in normal coronary artery patients.There was no significant difference between the two groups(P=0.219).Vulnerable Plaque and Coronary Heart Disease:Coronary atherosclerotic heart disease,defined as plaque stenosis is greater than or equal to 50%,was found in 324 cases(30.3%).NAFLD accounted for 34.0%in patients with coronary heart disease and 27.7%in non coronary heart disease.The former was significantly higher than the latter(P=0.038).There were 201 cases of CHD with vulnerable plaque,accounting for 62.0%,and 146 cases of non-CHD with vulnerable plaque,accounting for 19.6%.The proportion of vulnerable plaque in CHD group was significantly higher than that in non-CHD group(P<0.001).There were 206 cases of acute coronary syndrome,accounting for 19.3%of the total.The proportion of NAFLD in the ACS group was 36.9%,and that in the non-ACS group was 27.8%,the former was significantly higher than the latter(P=0.010).The proportion of vulnerable plaques was 88.8%in ACS group and 19.0%in non-ACS group,the former was significantly higher than the latter(P<0.001).Prognostic analysis of NAFLD:The cohort was followed up for an average of 4.6±1.3 years(0.3-6.7 years).114 cases(10.7%)of all-cause deaths,49 cases(4.6%)of cardiac deaths,75 cases(7.0%)of elective coronary revascularization,and 49 cases(4.6%)of non-fatal myocardial infarction were reported.The composite cardiovascular adverse events occurred in 220(20.6%)patients.All-cause mortality was 12.0%in NAFLD group and 10.1%in non-NAFLD group,with no significant difference(P=0.514).Cardiac mortality,elective coronary revascularization and non-fatal myocardial infarction were 7.0%,15.5%and 9.5%in NAFLD group,and 3.6%,3.5%and 2.5%in non-NAFLD group.The above prognostic parameters in NAFLD group were significantly worse than those in non-NAFLD group(P values were 0.044,<0.001,<0.001,respectively).NAFLD subgroup analysis:NAFLD subgroup(n=316)was divided into vulnerable plaque group(NAFLD+VP(+)group,n=130)and non-vulnerable plaque group(NAFLD+VP(-)group,n=186)according to the presence or absence of vulnerable plaques on coronary CTA.All-cause mortality,cardiac death,elective coronary artery reconstruction rate,non-fatal myocardial infarction rate,composite cardiovascular adverse event rate in NAFLD+VP(+)group were 20.8%,12.3%,25.4%,13.8%,52.3%,NAFLD+VP(-)group were 5.9%,3.2%,8.6%,6.5%,20.4%,the former were significantly higher than the latter(P values were<0.001,0.002,<0.001,0.032,and<0.001 respectively).Prognosis of vulnerable plaque and non-vulnerable plaque patients:There were 678 patients with coronary plaques,which were divided into vulnerable plaque group(347)and non-vulnerable plaque group(331)according to the morphology of the plaques.All-cause mortality,cardiac mortality,elective coronary revascularization,non-fatal myocardial infarction,and composite cardiovascular adverse events were 21.9%,11.0%,13.8%,8.6%,38.0%in vulnerable plaque group,and 5.1%,2.1%,5.1%,2.7%,13.9%in non-vulnerable plaque group,respectively.The former was significantly higher than the latter(P values were<0.001,<0.001,<0.001,0.001,0.001).Effect of Statin on Prognosis of NAFLD:The NAFLD subgroup(n=316)was divided into NAFLD statin group(n=200)and NAFLD non-statin group(n=116)according to whether statins were taken or not.There was no significant difference in all-cause mortality and cardiac mortality between the two groups(13.5%vs 9.5%,P=0.280;9.0%vs 3.4%,P?0.055).The rate of elective coronary arterial revascularization,non-fatal myocardial infarction and composite cardiovascular adverse events in NAFLD statin group were significantly higher than those in NAFLD non-statin group(21.5%vs 5.2%,P<0.001;12.5%vs 4.3%,P=0.017;41.0%vs 20.7%,P<0.001).NAFLD is a risk factor for complex cardiovascular adverse events:Univariate COX regression analysis showed that NAFLD was associated with composite cardiovascular adverse events(HR:2.02(1.55-2.63),P<0.001).Multivariate COX regression analysis using 2 models correction indicated that NAFLD was a risk factor for composite cardiovascular adverse events,HR was 1.96,1.73,both P values are<0.001.Conclusion:The vulnerable plaque,multiple vulnerable plaques,obstructive vulnerable plaque rate and vulnerability characteristics of NAFLD were significantly higher than those of non-NAFLD patients.NAFLD was a risk factor for coronary vulnerable plaque.Although NAFLD did not affect all-cause mortality,cardiac mortality,elective coronary revascularization,non-fatal myocardial infarction,and composite cardiovascular adverse events were significantly higher in NAFLD than in non-NAFLD patients.NAFLD was a risk factor for composite cardiovascular adverse events.The prognosis of NAFLD with vulnerable plaques was worse than that of NAFLD without vulnerable plaques.Statins may have cardiovascular protective effects on NAFLD.