Thématique :
- Foie
Originalité :
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
  2019 Apr;69(4):1453-1463.  
  doi: 10.1002/hep.30223.  
  Relationship Among Fatty Liver, Specific and Multiple-Site Atherosclerosis, and 10-Year Framingham Score.  
  Pais R, Redheuil A, Cluzel P, Ratziu V, Giral P  


Despite a well-documented increase in the prevalence of subclinical atherosclerosis in patients with steatosis, the relationship among steatosis and atherosclerosis, specific atherosclerotic sites, multiple-site atherosclerosis, and cardiovascular risk prediction is incompletely understood. We studied the relationship among steatosis, atherosclerosis site, multiple-site atherosclerosis, coronary artery calcification (CAC), and 10-year Framingham Risk Score (FRS) in 2,554 patients with one or more cardiovascular risk factors (CVRF), free of cardiovascular events and other chronic liver diseases, and drinking less than 50 g alcohol/day. All patients underwent arterial ultrasound (carotid [CP] and femoral [FP] plaques defined as intima-media thickness (IMT) > 1.5 mm), coronary computed tomography scan (severe CAC if ≥ 100), 10-year FRS calculation, and steatosis detection by the fatty liver index (FLI, present if score ≥ 60). Patients with steatosis (36% of total) had higher prevalence of CP (50% versus 45%, P = 0.004) and higher CAC (181 ± 423 versus 114 ± 284, P < 0.001) but similar prevalence of FP (53% versus 50%, P = 0.099) than patients without steatosis. Steatosis was associated with carotid IMT and CAC, but not with FP, independent of age, diabetes, hypertension, and tobacco use (P < 0.001). Fifty-three percent of patients had at least 2-site atherosclerosis and steatosis was associated with at least 2-site atherosclerosis independent of age and CVRF (odds ratio = 1.21, 95% confidence interval 1.01-1.45, P = 0.035). Sixty-four percent of patients with steatosis had a FRS score of 10% or more. FLI was associated with FRS beyond the CVRF or the number of atherosclerosis sites (P < 0.001). Adding FLI to CVRF predicted an FRS greater than or equal to 10% better than CVRF alone (area under the receiver operating characteristic curve = 0.848 versus 0.768, P < 0.001).

Conclusion: Steatosis is associated with carotid and coronary, but not femoral atherosclerosis, and with cardiovascular mortality risk. The multiple-site involvement and quantitative tonic relationship could reinforce the prediction of cardiovascular mortality or events over classical CVRF or imaging-based detection of atherosclerosis.

Question posée
Est-ce que la stéatose contribue de façon indépendante à l’athérosclérose précoce et est-ce que cette association peut mieux prédire le risque cardiovasculaire ?
Question posée
Etude rétrospective à partir de la cohorte prospective de la Pitié-Salpétrière de patients ayant au moins un risque cardio-vasculaire mais sans évènement cardio-vasculaire, la stéatose étant présente si FLI ( fatty liver index)>60 . Ajouter le FLI au risque cardio-vasculaire prédit un score de risque de Framinghan >10% et fait mieux que le risque cardio-vasculaire seul. La stéatose est associée seulement à l’athérome carotidien et coronarien.

L’existence d’une stéatose semble ajouter un risque cardio-vasculaire mais pour l’instant, cela n’a pas de traduction en pratique clinique courante.