Objectives: Epidemiological evidence suggests that that both NAFLD and AVS have substantial independent role in the pathogenesis of cardiovascular disease. Few studies have reported the association between NAFLD and AVS in T2DM or general population, hence providing further evidence is required to corroborate their findings. Significant co-relation may exist which needs to be mitigated further to prove the association between Nonalcoholic fatty liver disease(NAFLD) and Aortic valve sclerosis in patients with T2DM. In such case, the presence of AVS might present an additional CVD risk factor among these groups of patients presenting further emphasis in evaluating global CVD risk.
The main objective of our study is to find the prevalence between aortic valve sclerosis and nonalcoholic fatty liver disease in a Chinese type 2 diabetic population, thus, providing further evidence on the clinical importance of evaluating the global CVD risk in this group of patients.
Materials and Methods: The study design was a descriptive, cross sectional study single center study. Patients admitted in the inpatient ward of endocrinology department of Sun-YAT Sen Memorial hospital, Guangzhou were selected from primary analysis. Patient admitted between 2012 and 2015 were analyzed for primary analysis. 642 patient’s records selected for final detailed analysis. Echocardiogram and Ultra sonogram were chosen as investigation modalities for Aortic valve sclerosis and Nonalcoholic fatty liver disease. Inclusion criteria included patients diagnosed with type 2 diabetes aged 18-80years of age who had undergone transthoracic echocardiography for various clinical reasons. Exclusion criteria included patients with chronic kidney disease (Creatinine>2.5 mg/dl, end-stage renal disease, prosthetic heart valves, rheumatic heart disease(RHD).Similarly patients with pre-existing history of myocardial infarction, coronary revascularization procedures, congestive heart failure, valvular heart disease, viral hepatitis, liver cirrhosis, hepatocellular carcinoma, liver abscess or other secondary causes of liver disease were excluded from further analysis.
Overall, NAFLD and AVS were present in 386 (60.1%) and 128 (19.9%) patients respectively.
In univariate regression analysis (Unadjusted Model), NAFLD was significantly associated with increased risk of prevalent AVS (OR 1.53, 95% CI 1.02–2.3,p=0.044).Even after multivariable regression model’s adjustments, there was 3.5-fold increased risk of prevalent AVS [OR], 3.56, 95% CI 2.0-6.4,p<0.0001. The Odds ratio for AVS prevalence among patients 55 years of age or younger was 1.06(95 percent confidence interval, 0.42 to 2.69), with an increased odds among patients older than 55 years(P for interaction<0.001).The odds ratio for AVS with estimated glomerular filtration rate 60ml/min or greater was 1.73(95 percent confidence interval, 0.87 to 3.43), with an increased odds among patients with estimated glomerular filtration rate lower than 60ml/min(P for interaction=0.008).The odds ratio of AVS was 0.91 (95 percent confidence interval, 0.47 to 1.75), among patients with high baseline triglycerides levels with increased odds with low triglycerides level(P for interaction=0.006).The odds ratio with patients meeting the criteria for Metabolic syndrome(present) was 1.17(95 percent confidence interval, 0.69 to 1.97), with an indication of increased AVS prevalence among patients without features of Metabolic syndrome(P for interaction=0.043). No significant interactions were observed among other subgroup variables; Sex, waist circumference, body mass index, Left ventricular mass index, Low density lipids-cholesterol and Systolic blood pressure.