Nafld and cardiovascular risks: clinic, diagnostic, features of therapy
https://doi.org/10.21518/2079-701X-2019-12-82-86
Abstract
The relationship between non-alcoholic fatty liver disease (NAFLD) and cardiovascular diseases (CVD) is considered. The main mechanisms for increasing the cardiovascular risks induced by NAFLD are insulin resistance, oxidative stress, endothelial dysfunction and inflammation. Dyslipidemia, arterial hypertension, type 2 diabetes mellitus, often present in patients with NAFLD, also contribute to an increase in cardiovascular risks. It is shown that with the progression of NAFLD, the risk of developing CVDs increases. Mortality of patients with NAFLD is mainly due to the development of CVD complications. Thus, NAFLD should be considered as an independent risk factor for CVD.
Treatment of NAFLD includes lifestyle modification (diet therapy, physical activity), as well as the use of drugs from different groups: omega-3 polyunsaturated fatty acids, statins, S-adenosylmethionine, essential phospholipids, ursodeoxycholic acid, metadoxine, glycyrrhizic acid, vitamin E, herbal drugs. In particular, the use of phospholipides, which has a high safety profile and is well tolerated when used, including with a combination of NAFLD and CVD, is justified.
About the Author
R. G. Myazin
Federal State Budgetary Educational Institution of Higher Education «Volgograd State Medical University» of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Myazin Roman Gennadyevich - PhD, gastroenterologist, therapist of high graduate category, propaedeutic of internal diseases department.
400131, Volgograd, pl. Pavshikh Bortsov, 1; +7 (8442) 98-92-95References
1. ChaLasani N., Younossi Z., Lavine J.E., et al. The Diagnosis and Management of Non-alcoholic Fatty Liver Disease: Practice Guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012;142(7): 592-1609.
2. Diagnosis and treatment of non-alcoholic fatty liver disease. Guidelines. Under the editorship of Acad. of RAS, Prof. V.T. Ivashkina. Russian Association for the Study of the Liver. M., 2015. (In Russ).
3. Ratziu V., Goodman Z., Sanyal A. Current efforts and trends in the treatment of NASH. Journal of Hepatology. 2015;62(1 Suppl):S65-75.
4. Rinella M.E. Nonalcoholic fatty liver disease: a systematic review. JAMA. 2015;313(22):2263-73.
5. Ivashkin V.T., Drapkina O.M., Maev I.V., et al. Prevalence of nonalcoholic fatty liver disease in patients of outpatient practice in the Russian Federation: results of DIREG 2 study. Ros. Zhurn. Gastroenterologii, Gepa-tologii, Koloproktologii. 2015;6:31-41. (In Russ).
6. Myazin R.G. Nonalcoholic fatty liver disease: new treatment options. Meditsinsky Sovet. 2014;13:18-20. (In Russ).
7. Statsenko M.E., Turkina S.V., Kosivtsova M.A., Tyshchenko I.A. Non-alcoholic fatty liver disease as a multisystem disease. Vestnik Volgogradskogo Gosudarstvennogo Universiteta. 2016;2(58):8-14. (In Russ).
8. Polunina T.E. Non-alcoholic fatty liver disease. Algorithm for diagnosis and management. Guidance manual. M.: Media Medica, 2014. (In Russ).
9. Myazin R.G. Modern aspects of treatment of non-alcoholic fatty liver disease. Meditsinsky Sovet. Gastroenterologia. 2017;15:39-42. (In Russ).
10. Ivashkin V.T., Mayevskaya M.V., Pavlov Ch.S. Clinical guidelines for the diagnosis and treatment of non-alcoholic fatty liver disease of the Russian Association for the Study of the Liver and the Russian Gastroenterological Association. Ros. Zhurn. Gastroenterologii, Gepatologii, Koloproktologii. 2016;26(2):24-42. (In Russ).
11. Shirokova E.N. Non-alcoholic fatty liver disease, hyperlipidemia, and cardiovascular risks. Consilium Medicum. 2017;8(2):74-76. (In Russ).
12. Bazhenova N.M. Platelet aggregation in patients with hypertensive disease in combination with non-alcoholic fatty liver disease in the presence of obesity. Gastroenterologia, 2018;52(4):216-221. (In Russ).
13. Stepanova M., Younossi Z.M. Independent association between nonalcoholic fatty liver disease and cardiovascular disease in the US population. Clin Gastroenterol Hepatol. 2012;10:646-50.
14. Day C.P, Anstee O.M., Targher G. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat. Rev. Gastroenterol. Hepatol. 2013;10;330-44.
15. Musso G., Gambino R., Cassader M., Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of noninvasive tests for liver disease severity. Ann Med. 2011;43:617-49.
16. Lazo M., Hernaez R., Bonekamp S. et al. Nonalcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ. 2011;343:d6891.
17. Kim D., Kim W.R., Kim HJ., Therneau T.M. Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States. Hepatology. 2013;57:1357-65.
18. Wong V.W., Wong G.L., Yip G.W. et al. Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease. Gut. 2011;60:1721-7.
19. Zhou YJ., Li Y.Y., Nie Y.O. et al. Natural course of nonalcoholic fatty liver disease in southern China: a prospective cohort study. J Dig Dis. 2012;13:153-60.
20. Treeprasertsuk S., Leverage S., Adams L.A. et al. The Framingham risk score and heart disease in nonalcoholic fatty liver disease. Liver Int. 2012;32:945-50.
21. Soderberg C., Stal P., Askling J. et al. Decreased survival of subjects with elevated liver function tests during a 28-year follow-up. Hepatology. 2010;51:595-602.
22. Ballestri S., Lonardo A., Bonapace S. et al. Risk of cardiovascular, cardiac and arrhythmic complications in patients with nonalcoholic fatty liver disease. World J Gastroenterol. 2014;20:1724-45.
23. Targher G., Day C.P, Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med. 2010;363:1341-50.
24. Oni E.T., Agatston A.S., Blaha MJ. et al. A systematic review: burden and severity of subclinical cardiovascular disease among those with nonalcoholic fatty liver; should we care? Atherosclerosis. 2013;230:258-67.
25. Roden M. Mechanisms of disease: hepatic steatosis in type 2 diabetes-pathogenesis and clinical relevance. Nat Clin Pract Endocrinol Metab. 2006;2(6):335-48.
26. Roytberg G.E., Sharkhun O.O., Platonova O.E., Ushakova T.I. Non-alcoholic fatty liver disease as a risk factor for atherosclerosis. Vestn. RGMU. 2008;6:5-10. (In Russ).
27. Palgova L.K. Risk groups for the development of non-alcoholic fatty liver disease: whom and how to screen. Effek-tivnaya Farmakoterapia. 2017;16:26-30. (In Russ).
28. Еганян Р.А. Роль неалкогольной жировой болезни печени в развитии сердечно-сосудистых заболеваний. Кардиосоматика. 2018;01:47-53. [Yeganyan R.A. The role of non-alcoholic fatty liver disease in the development of cardiovascular diseases. Kardiosomatika. 2018;01:47-53.] (In Russ).
29. Luo J., Xu L., Li J., Zhao S. Nonalcoholic fatty liver disease as a potential risk factor of cardiovascular disease. EurJ Gastroenterol Hepatol. 2015;27(3):193-9.
30. Li N., Zhang G.W., Zhang J.R. et al. Non-alcoholic fatty liver disease is associated with progression of arterial stiffness. Nutr Metab Cardiovasc Dis. 2015;25(2):218-23.
31. Pugh T.J., Kelly M.A., Gowinsankar S. et al. The landscape of genetic variation in dilated cardiomyopathy as surveyed by clinical DNA sequencing. Genet Med. 2014;16(8):601-8.
32. Perseghin G., Lattuada G., De Cobelli F. et al. Increased mediastinal fat and impaired left ventricular energy metabolism in young men with newly found fatty liver. Hepatology. 2008;47:51-8.
33. Hallsworth K., Hollingsworth K.G., Thoma C. et al. Cardiac structure and function are altered in adults with non-alcoholic fatty liver disease. J Hepatol. 2013;58:757-62.
34. Bonapace S., Perseghin G., Molon G. et al. Nonalcoholic fatty liver disease is associated with left ventricular diastolic dysfunction in patients with type 2 diabetes. Diabetes Care. 2012;35:389-95.
35. Targher G., Valbusa F., Bonapace S. et al. Non-alcoholic fatty liver disease is associated with an increased incidence of atrial fibrillation in patients with type 2 diabetes. PLoS One. 2013;8:e57183.
36. Iacobellis G., Barbarini G., Letizia C., Barbaro G. Epicardial fat thickness and nonalcoholic fatty liver disease in obese subjects. Obesity (Silver Spring). 2014;22:332-6.
37. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64:1388-402.
38. Shirokova E.N. Non-alcoholic fatty liver disease and cardiovascular risk (literature review). Phar-mateca. 2017;2:24-9. (In Russ).
39. Tutelyan V.A., Vyalkov A.I., Razumov A.N. et al. Scientific foundations of healthy nutrition. M.: Panorama, 2010. (In Russ).
40. Cardiovascular prophylaxis. National clinical guidelines. M., 2009. (In Russ).
41. Lazeb-nik L.B., Zvenigorodskaya L.A., Egorova E.G. Nonalcoholic fatty liver disease in dyslipidemia and insulin resistance: similarities and differences; differentiated approach to therapy. Experim. i Klin. Gastroenterologia. 2009;4:4-11. (In Russ).
42. Chesnokova L.V, Petrov I.M., Troshina I.A. et al. Effect of weight loss on the course of non-alcoholic fatty liver disease: results of 6-month prospective observation. Ros. Zhurn. Gastroenterologii, Gepatolo-gii, Koloproktologii. 2015;25(1):66-73. (In Russ).
43. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-402.
44. Chalasani N., Younossi Z., Lavine J.E. et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver American Gastroenterological Association. Hepatology. 2012;55(6):2005-23.
45. Essentiale® Forte N. Formal Patient Information Leaflet. Encyclopaedia of Registry of Medicinal Products. https://www.rlsnet.ru/tn_index_id_13197.htm. (In Russ).
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For citations:
Myazin RG. Nafld and cardiovascular risks: clinic, diagnostic, features of therapy. Meditsinskiy sovet = Medical Council. 2019;(12):82-86. (In Russ.) https://doi.org/10.21518/2079-701X-2019-12-82-86
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