Background:
Cardiovascular disease (CVD) is the leading cause of death in nonalcoholic fatty liver disease (NAFLD). Apolipoprotein B (apoB) and non-high density lipoprotein-C (NHDL-C) are positively associated with NAFLD in small studies. High apoB predicts atherosclerotic CVD even when NHDL-C is low, suggesting that apoB may be the strongest predictor of atherosclerotic risk in adults.
Objective:
To quantify associations between apoB, NHDL-C and the discordance between apoB and NHDL-C levels in young adulthood with prevalent NAFLD, and coronary artery calcium (CAC) in adults with NAFLD in midlife.
Methods:
CARDIA recruited young adults ages 18 to 30 years in 1985-86. Participants with complete baseline CVD risk factor data and year 25 (Y25) NAFLD assessment and CAC score were included. NAFLD was defined as noncontrast computed tomography (CT) liver attenuation ≤40 Hounsfield Units after exclusions for other causes of liver fat. Presence of CAC was defined as Agatston score >0 on CT. Baseline NHDL-C or apoB values were divided into tertiles and 4 mutually exclusive concordant/discordant groups, stratified based on being above or below median NHDL-C or apoB levels.
Results:
Analysis included 2,508 participants (baseline age: 27 ± 4 years; body mass index: 25 ± 4 kg/m
2
; 58% women; 53% white). Y25 NAFLD prevalence was 10%. Compared with the lowest tertile, higher odds of NAFLD were seen in the middle and high tertiles of both apoB and NHDL-C in separate adjusted models. High NHDL-C and low apoB, but not high apoB and low NHDL-C, discordance was associated with Y25 NAFLD in adjusted models. Among NAFLD participants (n=261), NHDL-C/apoB discordance was not associated with Y25 CAC. Highest odds of CAC were observed in NAFLD participants with high NHDL-C (
TABLE
).
Conclusion:
High NHDL-C is a strong early risk marker for both NAFLD and atherosclerosis among adults with NAFLD in midlife. Based on our study findings, the additional benefit of measuring apoB levels for risk stratification in adults with NAFLD is not apparent.
Association between plasminogen activator inhibitor‐1 in young adulthood and nonalcoholic fatty liver disease in midlife: CARDIA
