A systematic review of updated evidence-based links between carotid artery atherosclerosis and non-alcoholic fatty liver

Abstract

Non-alcoholic fatty liver disease, which has emerged as a public health problem worldwide, has been shown to be an active factor in the pathogenesis of atherosclerosis. The results of various studies have shown that there is a significant relationship between non-alcoholic fatty liver disease and increased intima-media thickness of the carotid artery and the incidence of carotid plaques. In this study, we aimed to review the studies that have been done so far on the relationship between non-alcoholic fatty liver disease and carotid artery atherosclerosis in the form of a systematic and comprehensive review study. Methods and Materials: This study is a systematic review and meta-analysis of all descriptive studies and coded indexed in English in Pubmed, Ovid, Scopus, ProQuest, Google Scholar, Web of Science and The Cochrane Library databases on the relationship between non-alcoholic fatty liver disease and atherosclerosis. Carotid artery examination has been performed in adult patients (over 18 years of age). Results: A total of 2301 articles were obtained, which after excluding duplicates and unrelated cases, finally collected 69 articles, and these articles amounted to a total of 56582 patients, including 26689 patients with non-alcoholic fatty liver disease and 38584 controls. Finally, 64 articles to measure the effect of non-alcoholic fatty liver disease on increased intima-media carotid thickness, 17 studies to measure the effect of non-alcoholic fatty liver disease on the incidence of carotid artery atherosclerotic plaque and 7 studies to evaluate the effect of nonalcoholic fatty liver disease on increased thickness. Carotid intima-media in diabetic patients was entered into meta-analysis by fixed random effects model. The results of this meta-analysis showed that the presence of non-alcoholic fatty liver disease was associated with a 66% increase in carotid intima-media thickness (p value <0.001, 95% CI 1.7-2.24, OR = 1.666), the presence of fatty liver disease. Non-alcoholic was significantly associated with an increase in the incidence of atherosclerotic plaques in the carotid arteries and increased the incidence of atherosclerotic plaques in the carotid arteries by 35% (p value <0.001; In the subgroup meta-analysis of 7 studies that were performed only on diabetic patients (non-alcoholic fatty liver disease group and control group were both diabetic patients) the results showed that in these patients the presence of non-alcoholic fatty liver disease with increasing intima-media thickness There was no significant relationship between carotid arteries (p value = 0.557, CI 95% -0.959 - 0.05, OR = 1.020). In a review study, the results showed that non-alcoholic fatty liver disease increases the thickness of the intima-media of the carotid artery and the incidence of atherosclerotic plaques in the carotid arteries. Therefore, it can be concluded that non-alcoholic fatty liver disease can increase the risk of cardiovascular disease. However, in a specific study in diabetic patients, the presence of non-alcoholic fatty liver disease was not significantly associated with increased carotid intima-media thickness. Therefore, diabetes, which is considered as one of the risk factors for cardiovascular disease, can mask the link between non-alcoholic fatty liver disease and atherosclerotic involvement of the carotid arteries.