Hepatic steatosis increases non-calcified plaque burden

Hepatic steatosis may raise the risk of major adverse cardiovascular events through increased non-calcified plaque burden, according to a study.

Researchers analysed data from the coronary CT arm of Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE). Hepatic steatosis was evaluated on non-contrast CT using standard hepatic and splenic attenuation methods. Coronary CT angiography was used to measure total, calcified, noncalcified, and low-attenuation plaque volume and burden (% vessel volume).

A total of 3,637 patients (mean age 60.6 years, 51.4 percent female) were included in the analysis. Hepatic steatosis was identified in 25.5 percent. Patients with vs without hepatic steatosis were slightly younger, more often male, had more cardiovascular risk factors, and had a higher rate of major adverse cardiovascular events (4.1 percent vs 2.5 percent; p<0.05 for all).

In multivariable analyses, hepatic steatosis was associated with increased non-calcified plaque burden (β, 0.15 percent, 95 percent confidence interval [CI], 0.04–0.27; p=0.008) and elevated risk of major adverse cardiovascular events (adjusted hazard ratio, 1.69, 95 percent CI, 1.12–2.54; p=0.012). The association between hepatic steatosis and major adverse cardiovascular events was observed regardless of atherosclerotic cardiovascular disease risk score, obesity, and obstructive stenosis.

In mediation analyses, noncalcified plaque burden mediated 11 percent of the association between hepatic steatosis and major adverse cardiovascular events.

These present data highlight the importance of integrated cardiometabolic risk assessment in patients undergoing coronary CT angiography, the researchers said.