- •Hepatic fat independently predicts high-risk coronary artery plaque features in FH.
- •Hepatic fat associates with higher low attenuation and non-calcified plaque volumes.
- •CT assessment of hepatic fat may add incremental value to CVD risk stratification.
Background & aims
Hepatic steatosis has been associated with increased risk of coronary artery disease. Individuals with familial hypercholesterolaemia have accelerated but variable progression of coronary artery disease. We investigated whether hepatic steatosis is associated with novel coronary atherosclerosis biomarkers in adults with heterozygous familial hypercholesterolaemia, using comprehensive coronary computed tomographic angiography.
We conducted a cross-sectional study of 213 asymptomatic patients with familial hypercholesterolaemia (median age 54.0 years, 59 % female) who underwent coronary computed tomographic angiography for cardiovascular risk assessment in an outpatient clinic. High-risk plaque features, plaque volume and pericoronary adipose tissue attenuation were assessed. From concurrently captured upper abdominal images, severity of hepatic steatosis was computed, as liver minus spleen computed tomography attenuation and stratified into quartiles.
Of 213 familial hypercholesterolaemia patients, 59 % had coronary artery calcium, 36 % obstructive coronary artery disease (≥50 % stenosis) and 77 % high-risk plaque features. Increasing hepatic steatosis was associated with higher calcium scores, more high-risk plaque features and presence of obstructive coronary artery disease. Hepatic steatosis was associated with the presence of high-risk plaque features (OR: 1.48; 95 % CI: 1.09–2.00; p = 0.01), particularly in the proximal coronary segments (OR: 1.52; 95 % CI: 1.18–1.96; p = 0.001). Associations persisted on multivariable logistic regression analysis adjusting for cardiometabolic factors, obstructive coronary artery disease and calcium score. Hepatic steatosis was associated with higher plaque volumes (Q4: 499 mm3 vs Q1: 414 mm3, p = 0.02), involving mainly low attenuation and noncalcified plaques (both p = 0.03). No differences in pericoronary adipose tissue attenuation were observed.
Hepatic steatosis is associated with multiple indices of advanced coronary atherosclerosis in familial hypercholesterolaemia patients, particularly high-risk plaque features, independent of conventional cardiovascular risk factors and markers. This may involve specific mechanisms related to hepatic steatosis.
Clinical trial number: N/A.
Abbreviations:ACS (acute coronary syndrome), ASCVD (atherosclerotic cardiovascular disease), BMI (body mass index), CAC (coronary artery calcium), CAD (coronary artery disease), CCTA (computed coronary tomographic angiography), CT (computed tomography), FH (familial hypercholesterolaemia), HDL (high-density lipoprotein), HRP (high-risk plaque), HS (hepatic steatosis), HU (Hounsfield unit), HUL-S (liver attenuation index), IQR (interquartile range), LAD (left anterior descending), LAP (low-attenuation plaque), LDL (low-density lipoprotein), NAFLD (non-alcoholic fatty liver disease), PCAT (pericoronary adipose tissue attenuation), PR (positive remodelling), PV (plaque volume), RCA (right coronary artery), RLP (remnant lipoprotein), SC (spotty calcification)
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Published online: November 30, 2022
Accepted: November 25, 2022
Received: June 4, 2022
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