Improved management of patients after acute coronary syndrome: using nonalcoholic fatty liver disease fibrosis score and ezetimibe?
Abstract
Prognostic factors in patients surviving acute coronary syndrome (ACS) depend on many clinical, morphological, functional and biochemical parameters. Those include age, sex, previous myocardial infarction/other cardiovascular events, type of myocardial infarction, ejection fraction of the left ventricle, number and extent of affected coronary arteries, C-reactive protein, values of troponin and NT-pro-brain-natriuretic peptide, and plenty of others.
Interestingly, among extensively discussed biomarkers, only diabetes mellitus, represented particularly by glycated hemoglobin (HbA1C) is mentioned in some studies as the representative of metabolic risk. Nevertheless, atherogenic dyslipidemia, together with diabetes mellitus by far the most common metabolic causative factor for coronary artery disease and serious clinical complications is not very frequently mentioned.
At the same time, diabetes mellitus and dyslipidemia could be effectively controlled by lifestyle measures and by pharmacotherapy with good results. However, behind dyslipidemia and diabetes mellitus there is almost always another important factor, named non-alcoholic fatty liver disease (NAFLD) closely linked to metabolic and cardiac disorders.
NAFLD was first considered as a strong risk factor mainly for liver cirrhosis, but during last several years evidence is growing that NAFLD is also closely related to atherosclerotic vascular disease and could be robust independent risk factors for not only cardiovascular but also for total morbidity and mortality. No data, however, till now were available regarding the role of NAFLD as independent prognostic factor after ACS.
Reliable diagnosis of NAFLD is also difficult to establish without liver biopsy and only surrogate endpoints are used in large human studies.