Mechanisms Linking Nonalcoholic Fatty Liver Disease with Coronary Artery Disease |
| |
Authors: | W?Nseir A?Shalata A?Marmor Email author" target="_blank">N?AssyEmail author |
| |
Institution: | (1) Departments of Internal Medicine, Holy Family Hospital, Nazareth, Israel;(2) Liver Unit, Ziv Medical Center, POB 1008, 13100 Safed, Upper Galilee, Israel;(3) Department of Cardiology, Ziv Medical Center, Safed, Israel;(4) Faculty of Medicine, Technion, Haifa, Israel; |
| |
Abstract: | The most common cause of death in patients with nonalcoholic fatty liver disease (NAFLD) is coronary artery disease (CAD),
not chronic liver disease. Fatty liver increases cardiovascular risk by classical (dyslipidemia, hypertension, diabetes) and
by less conventional mechanisms. Common pathways involved in the pathogenesis of fatty liver and CAD includes hepatic insulin
resistance and sub clinical inflammation. The hepatic insulin resistance state of fatty liver infiltration is characterized
by increased FFA, which causes lipotoxicity and impairs endothelium-dependent vasodilatation, increases oxidative stress,
and has a cardio toxic effect. Additional metabolic risk factors include leptin, adiponectin, pro inflammatory cytokines such
as IL-6, C-reactive protein and plasminogen activator inhibitor-1 (PAI-1)], which together lead to increased oxidative stress
and endothelial dysfunction, finally promoting coronary artery disease (CAD). When classical risk factors are superimposed
on fatty liver accumulation, they may further increase the new metabolic risk factors, exacerbating CAD. The clinical implication
is that patients with NAFLD are at higher risk (steatohepatitis, diabetes, obesity, atherogenic dyslipidemia) and should undergo
periodic cardiovascular risk assessment including the Framingham score, cardiac effort test, and measurement of intimae-media
thickening of the carotids arteries. This may improve risk stratification for CAD. |
| |
Keywords: | |
本文献已被 PubMed SpringerLink 等数据库收录! |
|