Liver fat is related to cardiovascular risk factors and subclinical vascular disease: the Rotterdam Study

Eur Heart J Cardiovasc Imaging. 2016 Dec;17(12):1361-1367. doi: 10.1093/ehjci/jew174. Epub 2016 Aug 22.


Aims: Increasing evidence suggests involvement of the amount of liver fat in the development of cardiovascular disease. We investigated the relation of liver fat with cardiovascular risk factors and subclinical vascular disease in the general population.

Methods and results: Between 2003 and 2006, 2351 persons from the population-based Rotterdam Study (mean age 69.6 ± 6.7 years, 47.2% males) underwent non-enhanced computed tomography. We measured the mean liver attenuation value in Hounsfield units and quantified the following markers of subclinical vascular disease: epicardial fat volume and volumes of coronary (CAC), aortic (AAC), extracranial (ECAC), and intracranial carotid calcification (ICAC). Using linear regression, we investigated associations between traditional cardiovascular risk factors and mean liver attenuation. We also investigated relations of mean liver attenuation with markers of subclinical vascular disease, adjusting for cardiovascular risk factors. We found strong associations of waist circumference, diastolic blood pressure, and diabetes with lower mean liver attenuation [multivariable-adjusted beta per unit increase in waist circumference: -2.54 (95% CI: -3.10; -1.99); diastolic blood pressure: -0.52 (95% CI: -0.88; -0.17); and the presence of diabetes: -21.91 (95% CI: -31.76; -12.06)]. Moreover, we found that larger mean liver attenuation values were associated with smaller volumes of epicardial fat and CAC, independent of cardiovascular risk factors [beta per 1-SD increase in mean liver attenuation value: -0.05 (95% CI: -0.08; -0.02) and -0.05 (95% CI: -0.10; -0.01), respectively].

Conclusion: Larger amounts of liver fat are related to larger volumes of epicardial fat and CAC, independent of traditional cardiovascular risk factors, providing important novel insights into the role of liver fat as a marker of vascular disease.

Keywords: CT; epidemiology; imaging; liver fat; steatosis; vascular disease.

MeSH terms

  • Adipose Tissue / pathology
  • Age Distribution
  • Aged
  • Cardiovascular Diseases / diagnostic imaging*
  • Cardiovascular Diseases / epidemiology*
  • Cohort Studies
  • Comorbidity
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / epidemiology
  • Fatty Liver / diagnostic imaging*
  • Fatty Liver / epidemiology*
  • Female
  • Humans
  • Image Processing, Computer-Assisted*
  • Incidence
  • Male
  • Middle Aged
  • Multidetector Computed Tomography / methods*
  • Odds Ratio
  • Pericardium / pathology
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sex Distribution
  • Survival Rate
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / epidemiology