The most common liver disease in the U.S., nonalcoholic fatty liver disease (NAFLD), has been linked to coronary plaque, according to a study published today in Radiology.

The disease, which affects between 20 and 30 percent of the population, increases the likelihood of the presence of plaques six-fold.

Led by Stefan B. Puchner, MD, of Massachusetts General Hospital in Boston, researchers set out to determine the association between NAFLD and the presence of high-risk coronary atherosclerotic plaque as assessed with coronary CT angiography.

For the study, NAFLD was defined as hepatic steatosis at nonenhanced CT without evidence of liver disease, liver cirrhosis or alcohol abuse.

The study scanned 445 patients who underwent both nonenhanced CT to assess calcium score and contrast–enhanced coronary CT angiography. The study cohort consisted of subjects randomized to the coronary CT angiography arm of the Rule Out Myocardial Infarction using Computer Assisted Tomography (ROMICAT) II trial.

Of these patients, 40.9 percent had evidence of NAFLD, and high-risk coronary plaque was more frequent in patients with NAFLD that in patients without.

Patients found to have NAFLD were older and more likely to be men. They had higher BMI and a higher prevalence of cardiovascular risk factors like hypertension, diabetes and dyslipidemia.

“NAFLD is associated with advanced high-risk coronary plaque, independent of traditional cardiovascular risk factors and the extent and severity of coronary artery disease,” Puchner and colleagues concluded.

Often associated with metabolic disorders, NAFLD risk factors share a strong overlap with traditional cardiovascular risk factors. The studies of relationships between NAFLD and coronary atherosclerosis suggest the two are related to metabolic syndrome.

Patients with NAFLD had more coronary plaque with high-risk plaque features such as low CT number and positive remodeling, and the association persisted after controlling for age, sex, BMI, smoking status and alcohol consumption.

“Our observation supports a relationship between NALFD and advanced high-risk coronary atherosclerosis, possibly related to dysregulated secretion of cytokines, increased oxidative stress and systemic inflammation,” the authors wrote.