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Progression to Cirrhosis Leads to Improvement in Atherogenic Milieu

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Abstract

Introduction

The prevalence of coronary artery disease (CAD) is high among patients with cirrhosis; however, the impact of it on cardiovascular disease (CVD) is not known. The aim of the current study was to evaluate CVD events in patients with cirrhosis and impact of cirrhosis on biomarkers of atherogenesis.

Methods

The study included 682 patients with decompensated cirrhosis referred for liver transplantation (LT) evaluation between 2010 and 2017. All patients were followed until they experienced a CVD event, non-cardiac death, liver transplantation or last follow-up. To evaluate mechanistic link, patients with NASH cirrhosis were propensity matched 1:2 to non-cirrhosis NASH patients and biomarkers of atherogenic risk were compared.

Results

The composite CVD outcome occurred in 23(3.4%) patients after a median follow-up period of 585 days (IQR 139, 747). A strong association between presence of any CAD and CVD event was noted (HR = 6.8, 95% CI 2.9, 15.9) that was independent of age, gender, BMI, and MELD score. In competing risk model, the combined rate of LT and non-cardiac was significantly higher when compared to the rate of CVD events. Marker of insulin resistance and inflammation-related markers were similar in patients with and without cirrhosis. Patients with cirrhosis were more likely to have reduced VLDL, sdLDL-C, LDL-C, and triglycerides. Interestingly, patients with cirrhosis had an increase in serum HDL-2, the anti-atherogenic lipoprotein, and adiponectin, a protective serum adipokine.

Conclusion

The risk of CVD events in patients with cirrhosis is low and may potentially be due to improvement in markers of atherogenic risk.

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Abbreviations

ApoA1:

Apolipoprotein A1

ApoB:

Apolipoprotein B

BMI:

Body mass index

CAD:

Coronary artery disease

CVD:

Cardiovascular disease

ECG:

Electrocardiogram

ESLD:

End-stage liver disease

HCV:

Hepatitis C virus

HDL:

High-density lipoprotein

HR:

Hazards ratio

Hs-CRP:

High-sensitivity C-reactive protein

LDL:

Low-density lipoprotein

Lp-PLA2:

Lipoprotein-associated phospholipase A2

LT:

Liver transplantation

MELD-Na:

Model for end-stage liver disease-sodium

NASH:

Nonalcoholic steatohepatitis

SR-BI:

Scavenger receptor BI

SD:

Standard deviations

sdLDL:

Small dense low-density lipoprotein

VCU:

Virginia Commonwealth University

VLDL:

Very low-density lipoprotein

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Funding

No funding/financial support was utilized for the research and manuscript.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Hunter-Holmes McGuire Veterans Affairs Medical Center, Virginia Commonwealth University, Richmond, VA, 23249, USA

    Samarth Patel, Genta Kakiyama, Jasmohan S. Bajaj, Arun Sanyal, William M. Pandak & Mohammad Shadab Siddiqui

  2. Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, USA

    Samarth Patel, Mohammad B. Siddiqui, Genta Kakiyama, Caroline Walker, Robert J. Minniti, Sherry Boyett, Jasmohan S. Bajaj, Arun Sanyal, William M. Pandak & Mohammad Shadab Siddiqui

  3. Department of Internal Medicine, Virginia Commonwealth University, Richmond, USA

    Anchalia Chandrakumaran, Masoud Faridnia, Jose Hernandez Roman & Michael V. Patrone

  4. Department of Biostatistics, Virginia Commonwealth University, Richmond, USA

    Viviana A. Rodriguez & Adam Sima

  5. School of Medicine, Virginia Commonwealth University, Richmond, USA

    Emily Zhang

  6. Division of Transplant Surgery, Virginia Commonwealth University, Richmond, USA

    Chandra Bhati

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  1. Samarth Patel
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Contributions

MSS, SP contributed to study concept and design, AC, MF, JHR, EZ, CW, MVP, RJM, and SB helped in acquisition of data, VR, AS contributed to data analysis, SP, MBS helped in drafting of the manuscript, AS, WP, GK, CB, and JB contributed to critical revision of the manuscript, and MSS helped study supervision.

Corresponding author

Correspondence to Samarth Patel.

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10620_2020_6196_MOESM1_ESM.tiff

Impact of end-stage liver disease on (A) total cholesterol, (B) low-density lipoprotein cholesterol, (C) high-density lipoprotein cholesterol, and (D) triglycerides (TIFF 314 kb)

Supplementary material 2 (TIFF 233 kb)

Supplementary material 3 (TIFF 264 kb)

Supplementary material 4 (TIFF 299 kb)

Supplementary material 5 (DOCX 13 kb)

Supplementary material 6 (DOCX 14 kb)

Supplementary material 7 (DOCX 26 kb)

Flow of patients over the study period (TIFF 702 kb)

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Patel, S., Siddiqui, M.B., Chandrakumaran, A. et al. Progression to Cirrhosis Leads to Improvement in Atherogenic Milieu. Dig Dis Sci 66, 263–272 (2021). https://doi.org/10.1007/s10620-020-06196-4

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  • DOI: https://doi.org/10.1007/s10620-020-06196-4

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