Hepatic fibrosis as an additional risk factor for the development of cardiovascular disorders in patients with type 2 diabetes mellitus with non-alcoholic fatty liver disease

Authors

  • O.M. Bilovol Kharkiv National Medical University Ministry of Health of Ukraine, Department of Clinical Pharmacology and Internal Medicine, L. Maloi ave., 2a, Kharkiv, 61039, Ukraine, Ukraine https://orcid.org/0000-0002-7003-4551
  • I.I. Kniazkova Kharkiv National Medical University Ministry of Health of Ukraine, Department of Clinical Pharmacology and Internal Medicine, L. Maloi ave., 2a, Kharkiv, 61039, Ukraine, Ukraine https://orcid.org/0000-0002-0420-8197
  • O.V. Zemlianitsyna SI «V. Danilevsky Institute for Endocrine Pathology Problems of the National Academy of Medical Sciences of Ukraine», Department of Clinical Endocrinology, Alchevskykh str., 10, Kharkiv, 61002, Ukraine, Ukraine https://orcid.org/0000-0001-9488-0464
  • I.P. Dunaieva Kharkiv National Medical University Ministry of Health of Ukraine, Department of Clinical Pharmacology and Internal Medicine, L. Maloi ave., 2a, Kharkiv, 61039, Ukraine, Ukraine https://orcid.org/0000-0003-3061-3230
  • I.P. Romanova SI «V. Danilevsky Institute for Endocrine Pathology Problems of the National Academy of Medical Sciences of Ukraine», Department of Clinical Endocrinology, Alchevskykh str., 10, Kharkiv, 61002, Ukraine, Ukraine https://orcid.org/0000-0002-5302-4490
  • O.D. Kurilo SI «V. Danilevsky Institute for Endocrine Pathology Problems of the National Academy of Medical Sciences of Ukraine», Department of Clinical Endocrinology, Alchevskykh str., 10, Kharkiv, 61002, Ukraine, Ukraine https://orcid.org/0000-0001-7031-8012
  • V.M. Sinaiko Kharkiv National Medical University Ministry of Health of Ukraine, Department of Psychiatry, Narcology and Medical Psychology, Aсademika Pavlova str.,46, Kharkiv, 61022, Ukraine , Ukraine https://orcid.org/0000-0002-5332-9753
  • N.O. Kravchun SI «V. Danilevsky Institute for Endocrine Pathology Problems of the National Academy of Medical Sciences of Ukraine», Department of Clinical Endocrinology, Alchevskykh str., 10, Kharkiv, 61002, Ukraine, Ukraine https://orcid.org/0000-0001-7222-8424

DOI:

https://doi.org/10.26641/2307-0404.2021.2.234639

Keywords:

type 2 diabetes mellitus, non-alcoholic fatty liver disease, cardiovascular diseases

Abstract

The aim of the study was to determine the relationship between the degree of progression of liver fibrosis and the risk of cardiovascular complications in patients with Type 2 diabetes mellitus (DM) with non-alcoholic fatty liver disease (NAFLD). The study included 110 patients with Type 2 diabetes (62 men and 48 women), the average age of the subjects was 52.07±1.11 years. All patients were divided into 2 groups: the main group included 72 patients with Type 2 diabetes with concomitant NAFLD (38 men and 34 women); the control group included 38 patients with Type 2 diabetes without clinical manifestations of NAFLD (24 men and 14 women). Patients of the main group were divided into 3 subgroups, taking into account the predominant pathological processes in the clinical picture. The division into subgroups was carried out in 2 stages: at the first stage, those with predominant manifestations of liver fibrosis (F2 or more) were selected from the general population of patients with Type 2 diabetes with NAFLD according to the results of liver elastography and the use of Bonacini and Metavir scales. The number of such patients was 29, which accounted for 40.3% of the total number of patients in the main group. The remaining patients were divided into 2 subgroups: 11 patients (15.3%) had non-alcoholic liver steatosis, and 32 patients (44.4%) had signs of non-alcoholic steatohepatitis (NASH). As a result of the study, it was found that the presence of liver fibrosis in patients with Type 2 diabetes with NAFLD is significantly more often associated with cardiovascular complications, such as arterial hypertension, coronary heart disease, myocardial infarction, stroke, diabetic retinopathy and nephropathy. A significant decrease in the ejection fraction (EF) was found in patients with Type 2 diabetes with concomitant NAFLD. At the same time, the number of patients with EF disorders of varying degrees in the main group significantly exceeded that in the comparison group (33.3% and 6.7%, respectively, p<0.001). The average values of left ventricular myocardial mass are significantly lower in patients with NASH and fibrosis formation compared to patients with NAFLD at the stage of fatty hepatosis. There was also a significant decrease in the size of the left and right atria in patients with NASH compared to both patients with steatosis and patients with fibrotic liver changes. Patients with predominant fibrotic changes in the liver are characterized by a relative decrease in myocardial mass, a decrease in final diastolic and systolic volumes and EF, which may indicate the development of diastolic dysfunction in them. It is shown that it is necessary to take into account in clinical practice not only the generally accepted stages of NAFLD, but also the predominant pathological process in the liver in patients with Type 2 diabetes, namely steatosis, manifestations of inflammation and fibrotic disorders. It is proved that fibrotic changes in the liver can develop at all stages of liver tissue damage.

References

[Diseases of adipose tissue] / under total. ed. AI. Dedova. Moskva: GEOTAR-Media; 2020. p. 224. Russian. doi: https://doi.org/10.33029/9704-5367-4-BOL-1-224

Vakalyuk II, Virstyuk NG. [Features of the process of fibrosis in a combination of cardiosclerosis and non-alcoholic fatty liver disease]. Clinical medicine. 2018;2:168-173. Russian. doi: https://doi.org/10.18821/0023-2149-2018-96-2-168-173

Zubov NN, Kuvakin VI. [Methods of multivariate statistical analysis of data in medicine: textbook]. As¬sociate Professor Zubov NN. Sankt-Peterburg: Publishing house LLC “Lithography Prin; 2017. p. 348. Russian.

Orlov VN. [Guide to electrocardiography]. 9th ed., Rev. Moskva: LLC "Medical Information Agency"; 2017. p. 560. Russian.

[Echocardiography from MK. Rybakova]: Manual: with the DVD-ROM attachment “Echocardiography from MK. Rybakova". Moskva: Vidar Publishing House; 2018. p. 600. Russian.

Adams LA, Anstee QM, Tilg H, Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut. 2017;66(6):1138-53. doi: https://doi.org/10.1136/gutjnl-2017-313884.

Koliaki C, Szendroedi J, Kaul K, et al. Adaptation of hepatic mitochondrial function in humans with nonalcoholic fatty liver is lost in steatohepatitis. Cell. Metab. 2015; 21:739-746. doi: https://doi.org/10.1016/j.cmet.2015.04.004

Сavalcante JL, Tamarappoo BK, Hachamovitch R, et al. Association of epicardial fat, hypertension, subclinical coronary artery disease, and metabolic syndrome with left ventricular diastolic dysfunction. Am. J. Cardiol. 2012;110(12):1793-8. doi: https://doi.org/10.1016/j.amjcard.2012.07.045

Bedossa P, Poynard T. Tthe French METAVIR Cooperative Study Group. An algorithm for grading activity in chronic hepatitis C. Hepatology. 1996;24:289-93. doi: https://doi.org/10.1002/hep.510240201

Bonacini M, Hadi G, Govindarajan S, Lind¬say KL. Utility of a discriminant score for diagnosing advanced fibrosis or cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol. 1997;92(8):1302-4.

Hagström H, Nasr P, Ekstedt M, et al. Cardiovascular risk factors in non-alcoholic fatty liver disease. Liver Int. 2019;39(1):197-204. doi: https://doi.org/10.1111/liv.13973

Tana C, Ballestri S, Ricci F, et al. Cardiovascular Risk in Non-Alcoholic Fatty Liver Disease: Mechanisms and Therapeutic Implications. Int J Environ Res Public Health. 2019;16(17):3104. doi: https://doi.org/10.3390/ijerph16173104

Clifford SM, Murphy DJ. Non-alcoholic fatty liver disease and coronary atherosclerosis-does myocardial glucose metabolism provide the missing link? J Nucl Cardiol. 2019;14.

doi: https://doi.org/10.1007/s12350-019-01783-z

International Diabetes Federation (IDF) Diabetes Atlas, 9th edn. Brussels, Belgium: International Diabetes Federation; 2019. р. 176.

Available from: https://www.diabetesatlas.org.

World Health Organization – Diabetes country profiles, 2016. Ukraine.

Available from: http://www.who.int/diabetes/country-profiles/ukr_en.pdf?ua=1

EASL-EASD-EASO Clinical Practice Guidelines, J. Hepatol. 2016;64(6):1388-402. doi: https://doi.org/10.1016/j.jhep.2015.11.004

Weinberg EM, Trinh HN, Firpi RJ, Bhamidi¬marri KR, et al. Lean Americans With Nonalcoholic Fatty Liver Disease Have Lower Rates of Cirrhosis and Comorbid Diseases. Clin Gastroenterol Hepatol. 2020;3:S1542-3565(20)30930-7. doi: https://doi.org/10.1016/j.cgh.2020.06.066

Liu Y, Zhong GC, Tan HY, Hao FB, Hu JJ. No¬nalcoholic fatty liver disease and mortality from all causes, cardiovascular disease, and cancer: a meta-analysis. Sci Rep. 2019;9(1):11124. doi: https://doi.org/10.1038/s41598-019-47687-3

Downloads

Published

2021-06-18

How to Cite

1.
Bilovol O, Kniazkova I, Zemlianitsyna O, Dunaieva I, Romanova I, Kurilo O, Sinaiko V, Kravchun N. Hepatic fibrosis as an additional risk factor for the development of cardiovascular disorders in patients with type 2 diabetes mellitus with non-alcoholic fatty liver disease. Med. perspekt. [Internet]. 2021Jun.18 [cited 2024Apr.15];26(2):126-34. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/234639

Issue

Section

CLINICAL MEDICINE