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Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of atherosclerotic cardiovascular disease (CVD). In order to explore the potential link of NAFLD with subclinical atherosclerosis, this meta-analysis comprehensively assessed the correlation of NAFLD and four surrogate markers of subclinical atherosclerosis.
PubMed, Embase and the Cochrane Library database were searched until the end of April 2017. Original studies investigating the association between NAFLD and subclinical atherosclerosis were included. The outcome data was extracted referring to the inclusion and exclusion criteria and pooled for the effect estimate using a random-effects model. Newcastle-Ottawa Quality Assessment Scale (NOS) was utilized to assess the quality of the included studies.
Of the 434 initially retrieved studies, 26 studies involving a total of 105,815 participants (including 41,368 NAFLD patients) were included in this meta-analysis. The NOS scores suggested the included studies were of high quality. The pooled effects estimate showed that subjects with NAFLD exhibited a significant independent association with subclinical atherosclerosis compared to non-NAFLD group (OR = 1.60, 95% CI = 1.45–1.78). Furthermore, subgroup analysis suggested the presence of NAFLD yielded remarkable higher risk of increased carotid artery intima-media thickness (CIMT)/plaques, arterial stiffness, coronary artery calcification (CAC) and endothelial dysfunction with OR [CI] values of 1.74 [1.47–2.06], 1.56 [1.24–1.96], 1.40 [1.22–1.60] and 3.73 [0.99–14.09], respectively.
In the present meta-analysis, we revealed a close link of NAFLD and subclinical atherosclerosis in light of four different indices. Patients with NAFLD might benefit from screening and surveillance of early atherosclerosis, thus facilitating the prediction of potential CVD burden, risk stratification and appropriate intervention in the long term.