Symptomatic and asymptomatic significant carotid artery disease in type 2 diabetes patients with non-alcoholic steatohepatitis 1
Due to its strong association with components of MetS, all representing risk factors for atherosclerosis, it has been suggested that NAFLD may involve an independent cardiovascular risk. Several studies (Targher et al 2006; Brea et al 2005) have demonstrated an association between carotid atherosclerosis and NAFLD by evaluating intima-media thickness (IMT), thus suggesting that the addition of NAFLD to the other components of the metabolic syndrome may represent an independent athero-genetic
... k (Hamaguchi et al 2008). Oxidative stress and sub-clinical systemic inflammation were incriminated in this patho-genetic link (Gastaldelli et al 2007; Yki-Jarvinen et al 2005). The purpose of this study was to assess the presence of significant carotid artery stenosis-symptomatic or asymptomatic-in type 2 diabetes mellitus patients with steatohepatitis, compared to diabetic patients without evidence of fatty liver (NAFLD) nor NASH phenotype negative. Abstract. Background: Type 2 diabetes mellitus (DMT2) is considered also an inflammatory disease. NAFLD, in its various forms, is a component of the metabolic syndrome (MetS) associated with abdominal obesity, impaired glucose tolerance / diabetes, dyslipidemia, hyperten-sion; all these represent atherogenic risk factors. Objective: The purpose of this study was to assess the presence of significant carotid artery stenosis (symptomatic or asymptomatic) in type 2 diabetes mellitus patients with steatohepatitis, compared to diabetic patients without evidence of fatty liver (NAFLD) nor NASH phenotype negative. Materials and methods: This cross-sectional study included 107 consecutive diabetic patients and 110 controls; ultrasound and a panel of serological biomarkers were used as non-invasive means to diagnose NASH. The controls were diabetic patients without criteria for fatty liver disease. Carotid ultrasonography was performed along with a set biochemical tests (hepatic liver tests, fasting plasma glucose, HbA1c, a panel of lipid components, hs-CRP, and a panel of serological biomarkers for NASH phenotype). Results: 30.84% of the total DMT2 with steatohepatitis, with long duration of the disease and poor metabolic control, had significant carot-id stenosis (both symptomatic and asymptomatic) vs. controls (10%), p<0.001. The prevalence of non-stenotic carotid atheromatosis was not significantly different in the two groups of diabetic patients (61.68% vs. 42.73%, p>0.05). Carotid atherosclerosis was present in 99 patients (92.52%) from the DMT2 and steatohepatitis group and in 58 subjects (52.73%) from the control group. We also found high levels of hs-CRP in the DMT2 patients with steatohepatitis, and extended carotid atherosclerosis vs. controls. Conclusions: In type 2 diabetic patients with stea-tohepatitis, the prevalence of CAD is higher than in controls, and the severe atherosclerotic lesions are more frequent in this high-risk group of patients. High levels of hs-CRP are linked to the severity of atherosclerotic lesions, and this situation requires an intensive and multifactorial management of the global cardiovascular risk.