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Int. J. Environ. Res. Public Health 2013, 10(8), 3409-3423; doi:10.3390/ijerph10083409
Article

Relationship between Retinal Vascular Caliber and Coronary Artery Disease in Patients with Non-Alcoholic Fatty Liver Disease (NAFLD)

1,2
,
1,3
,
4
,
2
 and
2,3,*
1 Department of Ophtalmology, Ziv Medical Centre, Safed 13100, Israel 2 Faculty of Medicine at Galilee, Bar Ilan University, Safed 13100, Israel 3 Liver Unit, Ziv Medical Centre, Safed 13100, Israel 4 Department of Radiology, Safed 13100, Israel
* Author to whom correspondence should be addressed.
Received: 22 May 2013 / Revised: 11 July 2013 / Accepted: 31 July 2013 / Published: 6 August 2013
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Abstract

Objective: To evaluate the relationship between retinal vascular caliber and cardiovascular disease in non-alcoholic fatty liver disease (NAFLD) patients without diabetes and hypertension. Methods: Intention to treat study of individuals who underwent cardiac computed tomography (CT) during a two year period. Coronary artery disease (CAD) was defined as stenosis of >50% in at least one major coronary artery. Liver and spleen density were measured by abdominal (CT); intima-media thickness (IMT) by Doppler ultrasound; retinal artery and vein diameter by colored-retinal angiography; and metabolic syndrome by ATP III guidelines. Serum biomarkers of insulin resistance, inflammation, and oxidant-antioxidant status were assessed. Results: Compared with 22 gender and age matched controls, the 29 NAFLD patients showed higher prevalence of coronary plaques (70% vs. 30%, p < 0.001), higher prevalence of coronary stenosis (30% vs. 15%, p < 0.001), lower retinal arteriole-to-venule ratio (AVR) (0.66 ± 0.06 vs. 0.71 ± 0.02, p < 0.01), higher IMT (0.98 ± 0.3 vs. 0.83 ± 0.1, p < 0.04), higher carotid plaques (60% vs. 40%, p < 0.001), higher homeostasis model assessment of insulin resistance (HOMA) (4.0 ± 3.4 vs. 2.0 ± 1.0, p < 0.005), and higher triglyceride levels (200 ± 80 vs. 150 ± 60, p < 0.005) than controls. Multivariate analysis showed fatty liver (OR 2.5; p < 0.01), IMT (OR 2.3 p < 0.001), and retinal AVR ratio (OR 1.5, p < 0.01) to be strongly associated with CAD independent of metabolic syndrome (OR 1.2, p < 0.05). Conclusions: Patients with smaller retinal AVR (<0.7) are likely to be at increased risk for CAD and carotid atherosclerosis in patients with NAFLD even without hypertension or diabetes.
Keywords: cardiovascular disease; fatty liver; retinal vascular calibre; retinal artery; retinal vein; cardiac CT; intimae media thickening cardiovascular disease; fatty liver; retinal vascular calibre; retinal artery; retinal vein; cardiac CT; intimae media thickening
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).
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Josef, P.; Ali, I.; Ariel, P.; Alon, M.; Nimer, A. Relationship between Retinal Vascular Caliber and Coronary Artery Disease in Patients with Non-Alcoholic Fatty Liver Disease (NAFLD). Int. J. Environ. Res. Public Health 2013, 10, 3409-3423.

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