Turk Kardiyol Dern Ars. 2007; 35(6): 354-359

The relationship between endothelial dysfunction and serum aminotransferase levels in nonalcoholic fatty liver disease

Aydın Yıldırım¹, Özer Soylu¹, Alper Aydın¹, Hakan Güveli², Mehmet Ergelen¹, Seden Çelık¹, Baris Güngör¹, Ender Özgün Çakmak¹, Fatih Uzun¹, Tuna Tezel^1
1Siyami Ersek Thoracic And Cardiovascular Surgery Center, Cardiology Department, Istanbul, Turkey
²Haydarpasa Numune Hospital; Internal Medicine Gastroenterology Department, Istanbul, Turkey

OBJECTIVES
We assessed endothelial dysfunction, a precursor finding of atherosclerosis, and its severity in relation with aminotransferase levels in patients with nonalcoholic fatty liver disease (NAFLD).

STUDY DESIGN
Fifty-two patients without chronic alcohol ingestion were found to have NAFLD on routine abdominal ultrasonographic examination. Aminotransferase enzyme levels were normal in 26 patients (mean age 47±10 years), and elevated in 26 patients (mean age 48±12 years). The brachial artery was examined with Doppler ultrasonography to determine endothelium-dependent flow-mediated dilation in response to reactive hyperemia. Nonendothelium-dependent vasodilation was assessed following sublingual nitroglycerine administration. The results were compared with those of a control group of 27 age- and sex-matched patients (mean age 52±11 years) without NAFLD.

RESULTS
Patients with NAFLD had significantly higher fasting plasma glucose, HDL-cholesterol and total cholesterol levels, but the two patient groups did not differ in this respect. Baseline brachial diameters were similar in all the groups. Flow-mediated dilatation in response to reactive hyperemia significantly decreased in both patient groups compared to controls, but this decrease was more prominent in patients with an elevated aminotransferase level (p=0.03). No significant differences were found between the three groups following nitroglycerine administration (p>0.05). Multivariate analysis showed NAFLD as an independent determinant of reduced endothelium-dependent vascular relaxation (beta= -0.574, p=0.000).

CONCLUSION
Our data suggest that elevated aminotransferase enzyme levels in patients with NAFLD may predict endothelial dysfunction and the risk for cardiovascular events.

Keywords: Brachial artery/ultrasonography, coronary arteriosclerosis/physiopathology, endothelium, vascular/ultrasonography; fatty liver/complications; risk factors

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