PURPOSE OF THE STUDY
To assess the prevalence of metabolic syndrome components (abdominal obesity, high-density lipoprotein cholesterol (HDL cholesterol), triglycerides, uric acid) markers of non-alcoholic fatty liver disease (NAFLD) in individuals with cardiovascular diseases (CVD), as well as association with new cases of CVD and mortality from CVD in a 4-year prospective observational study of a cohort of individuals who previously (2017) participated in the ESSE-RF2 epidemiological study.
MATERIAL AND METHODS
An analysis of data on the population of the region aged 25—64 years (random sample, n=1648) was performed in a 4-year prospective observational study of this cohort, tracking fatal and non-fatal cases of CVD. A retrospective assessment of risk factors for the development of CVD and death from CVD (age, smoking, obesity, abdominal obesity) and biochemical parameters (cholesterol, triglycerides, uric acid, creatinine, C-reactive protein, alkaline phosphatase, transaminases and others, according to the study protocol) was undertaken. to assess their contribution to the occurrence of cardiovascular accidents. The components of the metabolic syndrome, NAFLD markers in a cohort divided into two groups: with CVD (n=812) and without CVD (n=836) were studied to assess the association with new cases of CVD and CVD mortality.
RESULTS
Fatal and non-fatal CVD develop in residents of the Omsk region at the age of 56—59 years, in men 1.6 times more often and at a much younger age compared to women. Risk factors (abdominal obesity, BMI over 25 kg/m2, and smoking) were statistically significantly more common in individuals who had a fatal or non-fatal cardiovascular event, despite the fact that 13 (28%) of them were patients during their lifetime» without CVD. Moreover, in 4 out of 5 individuals with repeated fatal and non-fatal cardiovascular events (all women), abdominal obesity was detected. Abdominal obesity had 10 (76.9%) people out of 13 who died from CVD and 21 (61.8%) respondents out of 34 CVD patients. In 13 people who died from cardiovascular accidents, there were simultaneously up to 9 altered laboratory parameters, including indicators of the metabolic syndrome, identified 2—4 years before the death. The most common changes were as follows: the level of gamma-glutamyl transpeptidase — more than 55 U/l (53.8%), cholesterol — more than 5.2 mmol/l (34.5%), triglycerides — more than 1.7 mmol/l (34.5%), high-density lipoprotein cholesterol (HDL cholesterol) — less than 1.0 mmol/l in men and 1.2 mmol/l in women (34.5%). It is noteworthy that only about 30% of those who died from CVD had an elevated level of triglycerides and a reduced level of HDL cholesterol, while the leading component of the metabolic syndrome, abdominal obesity, was much more common — in 76.9% of cases. Statistically significant changes in respondents with CVD compared with persons without CVD were noted in the levels of alkaline phosphatase and alanine aminotransferase (ALT). The increase in the frequency of detection of elevated ALT levels in women with CVD (p=0.082) led to a statistically significant increase in the frequency of detection of elevated ALT levels in general in the group of respondents with CVD (p=0.014). ALT is a reliable marker of cytolysis characteristic of NAFLD in individuals with metabolic syndrome and CVD. A significant increase in the level of alkaline phosphatase in individuals with CVD (OR=3.384, p=0.028) may most likely reflect progressive osteoporosis. An increase in the level of alkaline phosphatase in 2 respondents with CVD was accompanied by an increase in the level of ALT, which made it possible to regard it as a marker of NAFLD.
CONCLUSION
Abdominal obesity can be considered as a risk factor for the development of fatal and non-fatal cardiovascular events, regardless of other components of the metabolic syndrome (increased triglyceride levels, decreased high-density lipoprotein cholesterol), including in individuals without diagnosed cardiovascular diseases.
