The Relationship between Carotid Artery Stenosis and the Severity of Fatty Liver in Patients with Coronary Artery Disease Who Are Candidates for Angiography

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder in developed societies, which can lead to inflammation, fibrosis, and even cirrhosis. Recent studies have also suggested an association between NAFLD and an increased risk of cardiovascular diseases through inflammatory mechanisms and insulin resistance. This study aimed to investigate the relationship between carotid artery stenosis and liver fibrosis severity in patients with coronary artery disease (CAD). Methods: In this cross-sectional study, 200 patients referred for coronary angiography at Shahid Beheshti hospital, Qom, Iran, in 2019 were evaluated. Based on carotid Doppler ultrasonographic findings, patients were divided into two groups: with and without carotid stenosis. The severity of fatty liver was assessed using ultrasound, and fibrosis was evaluated using the fibrosis-4 (FIB-4) index. Demographic, laboratory, and imaging data were analyzed using SPSS software. Results: Among 200 patients (mean age 58.04 years, 50.5% female), 50% had carotid stenosis. Patients with carotid stenosis had a grade II and III fatty liver (44% with grade 2-3 vs. 19% in the non-stenosis group, P=0.001) and a higher FIB-4 score (40% vs. 8%, P<0.001). Additionally, patients with high FIB-4 scores had more severe coronary artery involvement (62.5% with 2-3 vessel disease vs. 40.8%, P=0.003) and a higher prevalence of carotid stenosis (83.3% vs. 39.5%, P<0.001). Conclusion: This study demonstrated that liver fibrosis severity (based on the FIB-4 index) is significantly associated with carotid artery stenosis and coronary artery involvement. Therefore, assessing liver fibrosis may serve as a predictive marker for cardiovascular risk in patients with NAFLD. The use of non-invasive methods such as FIB-4 alongside ultrasonography is recommended for fibrosis evaluation.