ABSTRACT
Abstract Background and aims Non-alcoholic fatty liver disease (NAFLD) is a multisystem disease closely linked to cardiovascular disease (CVD). This study aims to investigate the connection between early-stage NAFLD and atherosclerosis, as well as the correlation between liver fibrosis and coronary heart disease while exploring underlying inflammatory mechanisms. Methods In this retrospective study, the authors analyzed data from 607 patients who underwent both coronary computed tomography angiography (CCTA) and abdominal ultrasonography (US). Logistic regression was utilized to examine the association between NAFLD and atherosclerosis, while mediation analysis was conducted to explore whether inflammatory markers mediate the link between liver fibrosis and coronary artery disease. Results Among the 607 patients included, 237 (39.0 %) were diagnosed with NAFLD through ultrasonography. After adjusting for traditional cardiovascular risk factors, ALT, and AST, NAFLD demonstrated a significant correlation with carotid intimal thickening (1.58, 95 % CI 1.04‒2.40; p= 0.034) and non-calcified plaque (1.56, 95 % CI 1.03‒2.37; p= 0.038). Additionally, fibrosis predictive markers, including FIB-4 > 1.3 (1.06, 95 % CI 2.30‒5.00; p= 0.035) and APRI (6.26, 95 % CI 1.03‒37.05; p= 0.046), independently correlated with coronary heart disease after adjusting for cardiovascular risk factors. Conversely, among systemic inflammatory markers, only the neutrophil-to-lymphocyte ratio (NLR) and systemic inflammatory response index (SIRI) are independently associated with coronary heart disease. ROC curve analysis indicated that combining predictive fibrosis markers or inflammatory markers with traditional cardiovascular risk factors enhanced the predictive accuracy for coronary heart disease. Mediation analysis revealed that NLR fully mediated the effect of liver fibrosis on coronary heart disease. Conclusion NAFLD is associated with carotid intimal thickening and non-calcified plaque, suggesting an increased cardiovascular risk. Furthermore, liver fibrosis independently increases the risk of coronary heart disease in the early-stage NAFLD population, and inflammation may play a fully mediating role in the effect of liver fibrosis on coronary heart disease. Early intervention is crucial for NAFLD patients to mitigate future major adverse cardiovascular events.
ABSTRACT
Abstract Objective: As a greater proportion of patients survived their initial cardiac insult, Chronic Heart Failure (CHF) is becoming a major cause of worldwide morbidity and mortality. However, the mechanism underlying the inflammation in patients with CHF has not yet been elaborated. This study aims to explore the associations between inflammation and CHF patients, and the predictive performance of inflammatory indicators in identifying patients with CHF. Methods: A matched case-control study was conducted by recruiting 385 patients who were diagnosed with CHF from January 2018 to December 2019 in The First Affiliated Hospital of Chongqing Medical University. Each CHF patient was matched against one control subject without CHF on the criteria of age, sex, Body Mass Index (BMI), smoking status, and comorbidities. The clinical data and systemic inflammatory indicators were compared between the two groups, independent risk factors of CHF were identified by multivariate regression analysis, and the predictive values of systemic inflammatory indicators for CHF were analyzed by Receiver Operating Characteristic (ROC) curve analysis. Results: After processed in the univariate and multivariate regression analysis models, three systemic inflammatory indicators (hs-CRP [high sensitivity C Reactive Protein], LMR [lymphocyte-to-monocyte ratio], and Monocyte-to-High-density-lipoprotein Ratio [MHR]) were considered as independent predictors of CHF, among which the hs-CRP exhibited the best predictive performance (AUC = 0.752, 95%CI 0.717‒0.786, p < 0.001), followed by LMR (AUC = 0.711, 95% CI 0.675‒0.747, p < 0.001) and MHR (AUC = 0.673, 95% CI 0.635‒0.710, p < 0.001). The three-indicator combination showed an improved diagnostic performance (AUC = 0.757, 95% CI 0.724‒0.791, p < 0.001). In addition, the results of subgroup comparisons demonstrated that hs-CRP and MHR were associated with the severity of CHF (p < 0.001). Conclusions: The systemic inflammatory indicators such as hs-CRP, LMR, and MHR were independently correlated with the attack of CHF and might be the complementary markers of the diagnosis of CHF. HIGHLIGHTS Two novel inflammation-related markers, LMR and MHR are associated with Chronic Heart Failure (CHF). LMR and MHR were first proposed to be the predictors of a diagnosis of CHF in this study, which suggested that inflammation was associated with CHF, and anti-inflammation therapy might be a potential target for future therapeutic interventions. Compared with special inflammatory indicators such as TNF or IL-1, LMR and MHR are routinely measured in clinical practice and less time-consuming, which makes them suitable for popularization.