Clinical Studies Reduced prevalence of ischemic events and abnormal supraortic flow patterns in patients with liver cirrhosis Annalisa Berzigotti, Andrea Bonfiglioli, Antonio Muscari, Giampaolo Bianchi, Silvia LiBassi, Mauro Bernardi and Marco Zoli Department of Internal Medicine, Cardioangiology, Hepatology, University of Bologna, Bologna, Italy Berzigotti A, Bonfiglioli A, Muscari A, Bianchi G, LiBassi S, Bernardi M, Zoli M. Reduced prevalence of ischemic events and abnormal supraortic flow patterns in patients with liver cirrhosis. Liver International 2005: 25: 331–336. r Blackwell Munksgaard 2005 Abstract: Background: A reduced prevalence of cardiovascular diseases has been reported in liver cirrhosis. However, studies focusing on supraortic district of cirrhotic patients are lacking. Methods: By ultrasound duplex scanning, the presence and severity of atherosclerotic plaques and flow pattern abnormalities were assessed in carotid and vertebral arteries of 118 cirrhotics aged 60.7  12.8 (1 standard deviation) years, and in 236 controls matched with cirrhotic patients according to age, sex and cigarette smoking. Results: Previous ischemic strokes were significantly less numerous in cirrhotic patients than in controls (0.8% vs. 10.5%; P 5 0.0009); also the prevalence of myocardial infarction was significantly reduced (1.7% vs. 6.4%; P 5 0.0532). Moreover, cirrhotic patients differed from controls for a lower prevalence of hypertension and hypercholesterolemia, and for a greater proportion of diabetics. Although the presence and severity of atherosclerotic plaques was similar in the two groups, liver cirrhosis was associated with a lower prevalence of abnormal flow patterns (13.6% vs. 29.2%; P 5 0.0011). The inverse association of hemodynamic changes with liver cirrhosis persisted after all main risk factors were simultaneously taken into account by multiple logistic regression. However, in the presence of hypertension, hypercholesterolemia and cigarette smoking, the ‘protective’ effect of cirrhosis on the occurrence of abnormal flow patterns was no longer detectable. Conclusions: Advanced liver disease is associated with a reduced prevalence of ischemic stroke, which seems to be related to a decreased prevalence of abnormal flow patterns in the supraortic vessels, especially among non-smokers. Key words: arteriosclerosis – carotid arteries – Doppler ultrasonography – liver cirrhosis – vertebral arteries Marco Zoli, MD, Department di Internal Medi- cine, Cardioangiology, Hepatology, S.Orsola- Malpighi Hospital, Via Albertoni 15, Bologna 40138, Italy Tel: 139 051 6362211 Fax: 139 051 6362210 e-mail: marco.zoli@unibo.it Received 23 January 2004, accepted 17 April 2004                                                                                                 In cirrhotic patients a reduced prevalence of cardiovascular events is commonly observed, although it has only occasionally been reported (1, 2). The coagulation and platelet abnormalities present in liver cirrhosis (3), as well as the tendency to low blood pressure values (4), might at least partially explain this sort of ‘protective’ role played by cirrhosis on the occurrence of ischemic events. As for the prevalence of athero- sclerosis in cirrhosis, data are still scanty, and few conflicting results were reported in studies per- formed on alcohol abusers (5–8). Furthermore, all these papers were based on autoptic studies, and data on living subjects are lacking. Echo-color-Doppler has widely been used in the study of the carotid district in the general population (9–11), and in recent years it has routinely been used in the screening of sub- jects at risk for cardiovascular diseases (12). If performed by experienced operators, duplex scanning may allow a non-invasive and accu- rate characterization of blood flow pattern and plaque morphology (echogenicity, thickness and degree of stenosis) (13, 14, 15). However, to date no specific ultrasound study on supraortic arterial vessels has yet been performed in cirrhotic patients. Thus, this study describes for the first time the prevalence and severity of atherosclerosis, as well as the flow changes, in the carotid and vertebral arteries of patients with liver cirrhosis, in com- parison with matched control subjects, as as- sessed in vivo by means of an echo-color- Doppler examination. Liver International 2005: 25: 331–336 Printed in Denmark. All rights reserved Copyright r Blackwell Munksgaard 2005 DOI: 10.1111/j.1478-3231.2005.01002.x 331