Cardiac risk stratification in patients with non-alcoholic fatty liver disease and cholelithiasis
DOI: 10.32364/2587-6821-2021-5-6-377-384
T.S. Krolevets1, M.A. Livzan1, N.A. Cherkashchenko2, A.V. Gorbenko1, N.A. Nikolaev1
1Omsk State Medical University, Omsk, Russian Federation
2West Siberian Medical Center of the Federal Medical and Biological Agency,
Omsk, Russian Federation
Aim: to increase the efficacy of patient management, to assess the risk of developing cardiovascular diseases (CVD) with the fatal outcome for 10 years in patients with comorbid cholelithiasis (C) and non-alcoholic fatty liver disease (NAFLD).
Patients and Methods: 183 patients with NAFLD participated in an open comparative study. The main group (n=88) consisted of subjects with comorbid NAFLD and C, of which 53 patients have a history of cholecystectomy (CE). The comparison group consisted of patients with NAFLD only (n=95). The risk of CVD with fatal outcome in the comorbid course of NAFLD and C was assessed according to the SCORE 2019 scale for regions with an increased risk. A scale of relative total CVD risk was used for people under 40 years of age.
Results: the detection rate of CHD, is positively correlated with comorbid course of NAFLD and C (25% — in the main group, and 9.47% — in the comparison group, χ2=7.83, p<0,01, rs=0,207, R<0.01), and the correlation increases among people with CE (rs=0,258, R<0,01). In the comparison group, prediabetes was significantly more commonly detected (χ2=8.24, p<0.01, r s=-0.212, p<0,01). Patients after CE had a higher level of LDL cholesterol (rs=0.228, p≤0.01). Patients with NAFLD are characterized by hyperleptinemia and leptin resistance along with insulin resistance. Patients after CE have the highest level of leptin (p<0.001). Subjects with a comorbid course of NAFLD, C and CE in the history have a significantly higher risk of CVD with the fatal outcome for 10 years (43.4%) (χ2=9.4140, p<0,01). A correlation of mean level between CE and high CVD risk was revealed (r=-0,4341, p≤0.01).
Conclusion: the factors causing the comorbid course of NAFLD and C are also concerning the CVD progression. Stratification of patients by CVD risk groups and metabolic status can become an indispensable tool in the clinicians’ arsenal.
Keywords: cardiovascular risk, non-alcoholic fatty liver disease, cholelithiasis, cholecystectomy.
For citation: Krolevets T.S., Livzan M.A., Cherkashchenko N.A. et al. Cardiac risk stratification in patients with non-alcoholic fatty liver disease and cholelithiasis. Russian Medical Inquiry. 2021;5(6):377–384 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-377-384.
Aknowledgement
The technical edition is supported by PRO.MED.CS Praha a.s.
About the authors:
Tatiana S. Krolevets — C. Sc. (Med.), Associate Professor of the Department of Outpatient Therapy and Internal Diseases, Omsk State Medical University; 12, Lenin str., Omsk, 644099, Russian Federation, ORCID iD 0000-0002-7452-7230.
Maria A. Livzan — Dr. Sc. (Med.), Professor, Head of the Department of Faculty Therapy and Gastroenterology, Rector; Omsk state Medical University; 12, Lenin str., Omsk, 644099, Russian Federation; ORCID iD 0000-0002-6581-7017.
Natalia A. Cherkashchenko — C. Sc. (Med.), Head of the Department of Internal Medicine, gastroenterologist, therapist, West Siberian Medical Center of the Federal Medical and Biological Agency; 127, Krasnyi Put’ str., Omsk, 644033, Russian Federation; ORCID iD 0000-0003-3743-143X.
Alexander V. Gorbenko — Inspector of the Department for the Development of Regional Healthcare and Medical Activities, Resident of the Department of Faculty Therapy and Gastroenterology, Omsk State Medical University; 12, Lenin str., Omsk, 644099, Russian Federation; ORCID iD 0000-0001-9703-9371.
Nikolay A. Nikolaev — Dr. Sc. (Med.), Associate Professor of the Higher Attestation Commission, Professor of the Department of Faculty Therapy and Gastroenterology, Vice-Rector for Medical Activities and Regional Healthcare, Omsk State Medical University; 12, Lenin str., Omsk, 644099, Russian Federation; ORCID iD 0000-0002-3758-4930.
Contact information: Tatyana S. Krolevets, e-mail: mts-8–90@mail.ru.
Financial Disclosure: The paper was prepared within the scope of a grant of the President of the Russian Federation for state support of leading scientific schools (NSH-2558.2020.7) (Agreement No. 075-15-2020-036 of March 17, 2020) "Development of health-preserving technology for patient with comorbid gastroenterological profile based on adherence control".
There is no conflict of interests.
Received 14.07.2021.
Revised 06.08.2021.
Accepted 31.08.2021.
2. Kobalava Zh.D., Konradi A.O., Nedogoda S.V. et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian journal of cardiology. 2020;25(3):3786 (in Russ.). DOI: 10.15829/1560-4071-2020-3-3786.
3. Drapkina O.M. Non-alcoholic fatty liver disease and metabolic syndrome. Spravochnik Poliklinicheskogo Vracha. 2008;(3):71–4 (in Russ.).
4. Moiseev V.S., Mukhin N.A., Smirnov A.V. et al. Cardiovascular risk and chronic kidney disease: strategies for cardio-nephroprotection. Russian journal of cardiology. 2014;(8):7–37 (in Russ.). DOI: 10.15829/1560-4071-2014-8-7-37.
5. Nikolaev N.A., Martynov A.I., Skirdenko Yu.P. et al. Treatment management based on adherence. Consilium Medicum. 2020;22(5):9–18 (in Russ.). DOI: 10.26442/20751753.2020.5.200078.
6. Myazin R.G. NAFLD and cardiovascular risks: clinical picture, diagnosis, features of therapy. Meditsinskiy sovet. 2019;(12):82–86 (in Russ.). DOI: 10.21518 / 2079-701X-2019-12-82-86.
7. Drapkina O., Korneeva O., Ivashkin V. Obesity in the practice of a cardiologist. Vrach. 2005;(1):45–47 (in Russ.).
8. Drapkina O.M., Yafarova A.A. Non-alcoholic fatty liver disease and cardiovascular risk: a problem state. Rational Pharmacotherapy in Cardiology. 2017;13(5):645–650 (in Russ.). DOI: 10.20996/1819-6446-2017-13-5-645-650.
9. Plotnikova E.Yu. Dyslipidemia in non-alcoholic fatty liver disease as a marker of cardiovascular risk. RMJ. Medical Review. 2019; 3(1–2):64–69 (in Russ.).
10. Siddiqui M.S., Fuchs M., Idowu M.O. et al. Severity of nonalcoholic fatty liver disease and progression to cirrhosis are associated with atherogenic lipoprotein profile. Clin Gastroenterol Hepatol. 2015;13(5):1000–1008.e3. DOI: 10.1016/j.cgh.2014.10.008.
11. Korneeva O.N., Drapkina O.M., Pavlov Ch.S. et al. Non-alcoholic steatohepatitis in metabolic syndrome. Gastroenterology Supplement to the Consilium Medicum J. 2007;(2):18–21 (in Russ.).
12. Drapkina O.M., Korneeva O.N. The continuum of non-alcoholic fatty liver disease: from hepatic steatosis to cardiovascular risk. Rational Pharmacotherapy in Cardiology. 2016;12(4):424–429 (in Russ.). DOI: 10.20996/1819-6446-2016-12-4-424-429.
13. Cherkashchenko N.A., Livzan M.A., Krolevets T.S. Chebanenko E.V. The system of support for medical decisions on the prediction of metabolic risks in patients with a comorbid course of non-alcoholic fatty liver disease and cholelithiasis after cholecystectomy. Medical alphabet. 2020;1(30):11–17 (in Russ.). DOI: 10.33667/2078-5631-2020-30-11-17.
14. Fan L.L., Chen B.H., Dai Z.J. The relation between gallstone disease and cardiovascular disease. Sci Rep. 2017;7(1):15104. DOI: 10.1038/s41598-017-15430-5.
15. Ivashkin V.T., Mayevskaya M.V., Pavlov Ch.S. et al. Clinical guidelines for the diagnosis and treatment of non-alcoholic fatty liver disease of the Russian Society for the Study of the Liver and the Russian Gastroenterological Association. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2016;26(2):24–42 (in Russ.). DOI: 10.22416/1382-4376-2016-26-2-24-42.
16. Ata N., Kucukazman M., Yavuz B. et al. The metabolic syndrome is associated with complicated gallstone disease. Can J Gastroenterol. 2011;25(5):274–276. DOI: 10.1155/2011/356761.
17. Shen C., Wu X., Xu C. et al. Association of cholecystectomy with metabolic syndrome in a Chinese population. PLoS One. 2014;9(2):e88189. DOI: 10.1371/journal.pone.0088189.
18. Mekhtiev S.N., Mekhtieva O.A. Cholelithiasis and non-alcoholic fatty liver disease: combination and prognosis. Lechashchiy Vrach. 2017;(3):77 (in Russ.).
19. Gruzdeva O., Borodkina D., Uchasova E. et al. Leptin resistance: underlying mechanisms and diagnosis. Diabetes Metab Syndr Obes. 2019:191–198. DOI: 10.2147/DMSO.S182406.
20. Saxena N.K., Anania F.A. Adipocytokines and hepatic fibrosis. Trends Endocrinol Metab. 2015;26(3):153–161. DOI: 10.1016/j.tem.2015.01.002.
21. Pan H., Guo J., Su Z. Advances in understanding the interrelations between leptin resistance and obesity. Physiol Behav. 2014;130:157–169. DOI: 10.1016/j.physbeh.2014.04.003.
22. Livzan M.A., Akhmedov V.A., Krolevets T.S. et al. Informative value of non-invasive markers of liver fibrosis in patients with non-alcoholic fatty liver disease. Terapevticheskiy arkhiv. 2016;88(12):62–68 (in Russ.). DOI: 10.17116/terarkh2016881262-68.
23. Méndez-Sánchez N., Ponciano-Rodrigoez G., Chavez-Tapia N., Uribe M. Effects of leptin on biliary lipids: potential consequences for gallstone formation and therapy in obesity. Curr Drug Targets Immune Endocr Metabol Disord. 2005;5(2):203–208. DOI: 10.2174/1568008054064896.
24. Saraç S., Atamer A., Atamer Y. et al. Leptin levels and lipoprotein profiles in patients with cholelithiasis. J Int Med Res. 2015 Jun;43(3):385–392. DOI: 10.1177/0300060514561134.
25. Younossi Z.M., Stepanova M., Rafiq N. et al. Nonalcoholic steatofibrosis independently predicts mortality in nonalcoholic fatty liver disease. Hepatol Commun. 2017;1(5):421–428. DOI: 10.1002/hep4.1054.
26. Henson J.B., Simon T.G., Kaplan A. et al. Advanced fibrosis is associated with incident cardiovascular disease in patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2020;51(7):728–736. DOI: 10.1111/apt.15660.
27. Targher G., Byrne C.D., Lonardo A. et al. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: A meta-analysis. J Hepatol. 2016;65(3):589–600. DOI: 10.1016/j.jhep.2016.05.013.
28. Golabi P., Otgonsuren M., de Avila L. et al. Components of metabolic syndrome increase the risk of mortality in nonalcoholic fatty liver disease (NAFLD). Medicine (Baltimore). 2018;97(13):e0214. DOI: 10.1097/MD.0000000000010214.
29. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016;65(1):146–181. DOI: 10.1016/j.jhep.2016.03.005.
30. Ivashkin V.T., Mayev I.V., Baranskaya E.K. and other. Recommendations of the Russian Gastroenterological Association for the diagnosis and treatment of gallstone disease. Russian journal of gastroenterology, hepatology, coloproctology. 2016;26(3):64–80 (in Russ.). DOI: 10.22416/1382-4376-2016-26-3-64-80.
31. Mayevskaya M.V., Ivashkin V.T., Ivashkin K.V. et al. Non-alcoholic fatty liver disease as a cause and consequence of cardiometabolic complications. Features of pharmacotherapy. Place of ursodeoxycholic acid. Terapevticheskiy arkhiv. 2019;91(2):109–117 (in Russ.). DOI: 10.26442/00403660.2019.02.000122.
32. Boytsov S.A., Chuchalin A.G. Dispensary observation of patients with chronic non-infectious diseases and patients with a high risk of their development: guidelines. Moscow: Russian Society for the Prevention of Noncommunicable Diseases; 2014 (in Russ.).
33. Korneeva O.N., Drapkina O.M. Possibilities of using ursodeoxycholic acid and statins to reduce cardiovascular risk in patients with metabolic syndrome and non-alcoholic fatty liver disease. Meditsinskiye Vesti. 2011;16(3):57–63 (in Russ.).
34. Nadinskaia M., Maevskaya M., Ivashkin V. et al. Ursodeoxycholic acid as a means of preventing atherosclerosis, steatosis and liver fibrosis in patients with nonalcoholic fatty liver disease. World J Gastroenterol. 2021;27(10):959–975.
This work is licensed under a Creative Commons «Attribution» 4.0 License.
