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Increasing aortic stiffness is predictive of advanced liver fibrosis in patients with type 2 diabetes: the Rio‐T2 DM cohort study
Author(s) -
Leite Nathalie C.,
VillelaNogueira Cristiane A.,
Ferreira Marcel T.,
Cardoso Claudia R. L.,
Salles Gil F.
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12994
Subject(s) - medicine , pulse wave velocity , transient elastography , cardiology , arterial stiffness , cohort , fibrosis , odds ratio , gastroenterology , fatty liver , liver fibrosis , disease , blood pressure
Background & Aims Type 2 diabetes mellitus (T2 DM ) is a risk factor for cardiovascular disease ( CVD ) and advanced stages of non‐alcoholic fatty liver disease ( NAFLD ). The aim was to evaluate the association between aortic stiffness, a preclinical CVD marker, with advanced liver fibrosis identified by transient elastography ( TE ) in T2 DM outpatients with NAFLD . Methods This longitudinal study included 291 T2 DM patients with NAFLD detected by ultrasonography, who had two carotid‐femoral pulse wave velocity (cf‐ PWV ) measurements and a TE examination (Fibroscan ® ) performed over a median follow‐up of 7 years. Advanced liver fibrosis (corresponding to ≥ F3 stage) was considered as median values >7.9 kPa (M probe) or >7.2 kPa ( XL probe). Increased aortic stiffness was defined as cf‐ PWV >10 m/s. Results Eighty patients (27.5%) had advanced liver fibrosis. Overall, there was an increase in cf‐ PWV of 0.1 m/s/year (1% per year). Both a high aortic stiffness at the 2nd cf‐ PWV examination [odds ratios ( OR ): 3.0; 95% CI : 1.3–7.2; P = 0.011] and a serial increase in aortic stiffness ( OR : 2.1; 95% CI : 1.0–4.3; P = 0.046) were associated with increased odds of having advanced liver fibrosis. Patients who presented either an increase in aortic stiffness or persisted with high values had significantly higher mean liver stiffness than those who either decreased aortic stiffness or persisted with normal cf‐ PWV values (mean difference: 2.1 kPa, 95% CI : 0.5–3.7 kPa, P = 0.012), after adjustments for anthropometric‐demographic and clinical laboratory covariates. Conclusions In T2 DM patients with NAFLD , a high or increasing aortic stiffness predicted development of advanced liver fibrosis on TE .