The role of non-alcoholic fatty liver disease in the development of vascular rigidity and cardiovascular risk in patients with arterial hypertension

Abstract

Purpose. To assess the parameters of lipid and carbohydrate metabolism, insulin resistance, chronic low-intensity systemic inflammation, structural and functional parameters of the liver in patients with hypertension (AH) and non-alcoholic fatty liver disease (NAFLD) compared with patients with isolated AH, as well as the impact of changes in these parameters on reducing the elasticity of the main arteries and increasing the risk of cardiovascular complications in patients with comorbid pathology.Material and methods. A comparative cross-sectional study was carried out, which included 120 patients, aged 45 to 65, with AH grade I-II, stages 1-2 (with (FLI≥60) and without NAFLD). During the initial examination, a clinical examination was carried out, the parameters of lipid, carbohydrate and structural-functional parameters of the liver were assessed. The severity of chronic systemic inflammation and insulin resistance were also assessed. Pulse wave velocity (PWV), central aortic pressure (CAP), vascular age and total cardiovascular risk were measured according to the SCORE scale.Results. The data obtained indicate a more pronounced insulin resistance, chronic systemic inflammation, as well as significantly higher lipid metabolism in patients with AH and NAFLD in comparison with patients with isolated AH. In addition, in patients of this group, the indicators of PWV and CAP were significantly higher, and patients with AH and NAFLD had a higher 10-year fatal risk (p=0.013). The performed ROC analysis showed that at FLI≥60, a high risk of PWVm>10m/s is predicted. Multiple regression analysis found that an increase in VLDL cholesterol leads to an increase in the values of both PWVe (p<0.001) and PWVb (p=0.048). The 10-year fatal risk (SCORE) in patients with AH and NAFLD increased with an increase in PWVe (p=0.021), FLI (p=0.013), and visceral obesity (p<0.001).Conclusion. The study shows that in patients with AH and NAFLD, compared with patients with isolated AH, the indicators of insulin resistance and chronic low-intensity systemic inflammation are significantly higher, the highly atherogenic type of hyperlipidemia and visceral obesity are more often found. Also, in comorbid patients with AH, statistically significant higher values of CAP and augmentation index are determined. Stiffness indices of the great arteries were also significantly higher in patients with comorbid pathology. The ROC analysis showed that at FLI≥60, a high risk of PWVm>10 m/s was predicted, which is associated with the development of cardiovascular complications. Also, multiple regression analysis showed that the increase in PWVe and PWVm was mainly due to an increase in VLDL cholesterol, and the 10-year fatal cardiovascular risk of complications had the greatest increase with an increase in the values of PWVe, FLI and visceral obesity.