Evaluation of early atherosclerosis markers in patients with nonalcoholic fatty liver disease Metin Kucukazman a , Naim Ata b , Bunyamin Yavuz c , Kursat Dal b , Omer Sen c , Onur S. Deveci c , Kadir Agladioglu d , Abdullah O. Yeniova a , Ya ¸ sar Nazligul a and Derun T. Ertugrul b Objectives Nonalcoholic fatty liver disease (NAFLD) is characterized by the excessive accumulation of fat in the liver cells. It is strongly associated with cardiovascular risk factors for atherosclerosis. Flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) are noninvasive methods for the evaluation of endothelium. They are considered early markers of atherogenesis. The aim of this study was to evaluate early atherosclerosis markers in patients with NAFLD. Methods We examined 161 patients. All the patients underwent hepatic ultrasonography, transthoracic echocardiography, and brachial artery and carotid artery imaging. Fasting blood samples were drawn from all patients for the determination of lipids, insulin, C-peptide, and fasting blood glucose. HOMA-IR was calculated. Results Among the 161 patients, 44 had normal hepatic ultrasonography, 42 had stage 1 hepatosteatosis, 53 had stage 2 hepatosteatosis and 22 had stage 3 hepatosteatosis. FMD was reduced in patients with NAFLD as compared with the healthy controls (5.9±3.1 vs. 9.6±2.7%, P < 0.001). There was a significant negative moderate correlation between ultrasonographic hepatosteatosis grade and FMD (r = – 0.556, P < 0.001). The mean CIMT was significantly increased in patients with NAFLD as compared with the controls (0.40±0.19 vs. 0.27±0.18, P < 0.001). There was a significant positive weak correlation between ultrasonographic hepatosteatosis grade and mean CIMT (r = 0.376, P < 0.001). Conclusion This study showed that NAFLD is associated with impaired CIMT and FMD, which are early markers of atherosclerosis. These findings may play a crucial role in understanding the pathophysiology of the atherosclerotic process in patients with NAFLD. Eur J Gastroenterol Hepatol 25:147–151  c 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2013, 25:147–151 Keywords: atherosclerosis, carotid intima-media thickness, flow-mediated dilation, nonalcoholic fatty liver disease a Department of Internal Medicine, Division of Gastroenterology, Departments of b Internal Medicine, c Cardiology and d Radiology, Kecioren Teaching and Research Hospital, Ankara, Turkey Correspondence to Metin Kucukazman, MD, Department of Internal Medicine, Division of Gastroenterology, Kecioren Teaching and Research Hospital, 06380 Ankara, Turkey Tel: + 90 312 3569000; fax: + 90 312 3569002; e-mail: drmetingastromd@gmail.com Received 24 July 2012 Accepted 12 September 2012 Introduction Nonalcoholic fatty liver disease (NAFLD) is a common condition worldwide. It is characterized by the excessive accumulation of fat in the liver cells [1,2]. Patients with NAFLD have higher morbidity and mortality rates [3]. It is also strongly associated with risk factors for athero- sclerosis, such as obesity, dyslipidemia, hypertension, type 2 diabetes mellitus, and insulin resistance [4]. The increased risk of atherosclerosis in patients with NAFLD is because of the coexistence of this entity with metabolic syndrome. NAFLD has been accepted recently as a hepatic component of metabolic syndrome [5]. Brachial artery flow-mediated dilation (FMD) is a non- invasive method for the determination of endothelial function in humans. Endothelial dysfunction is a char- acteristic of most conditions associated with athero- sclerosis and thus it is considered as an early marker for atherogenesis. When endothelial dysfunction is present, lower levels of FMD are detected [6,7]. Carotid intima- media thickness (CIMT), which is another early athero- sclerotic marker, was positively related to the severity of coronary artery and cardiovascular events [8]. There are several papers on the association between NAFLD and subclinical atherosclerosis in patients with a low cardiovascular risk. However, the literature is controversial about it. The aim of this study was to evaluate endothelial function in patients with NAFLD using FMD. Methods We examined 161 patients who were referred to the outpatient clinic of the Division of Gastroenterology for the determination of hepatic function. According to the hepatic ultrasonographic findings, we divided the patients into four groups: those with normal hepatic ultrasono- graphy (USG), those with stage 1 hepatosteatosis, those with stage 2 hepatosteatosis, and those with stage 3 hepatosteatosis [9]. The study protocol was in accordance Original article 147 0954-691X  c 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MEG.0b013e32835a58b1 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.