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Brouwers, Martijn C. G. J.; Simons, Nynke; Stehouwer, Coen D. A.; Isaacs, Aaron

Non-alcoholic fatty liver disease and cardiovascular disease: assessing the evidence for causality

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  • Medientyp: E-Artikel
  • Titel: Non-alcoholic fatty liver disease and cardiovascular disease: assessing the evidence for causality
  • Beteiligte: Brouwers, Martijn C. G. J.; Simons, Nynke; Stehouwer, Coen D. A.; Isaacs, Aaron
  • Erschienen: Springer Science and Business Media LLC, 2020
  • Erschienen in: Diabetologia
  • Sprache: Englisch
  • DOI: 10.1007/s00125-019-05024-3
  • ISSN: 0012-186X; 1432-0428
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:title>Abstract</jats:title><jats:p>Non-alcoholic fatty liver disease (NAFLD) is highly prevalent among individuals with type 2 diabetes. Although epidemiological studies have shown that NAFLD is associated with cardiovascular disease (CVD), it remains unknown whether NAFLD is an active contributor or an innocent bystander. Plasma lipids, low-grade inflammation, impaired fibrinolysis and hepatokines are potential mediators of the relationship between NAFLD and CVD. The Mendelian randomisation approach can help to make causal inferences. Studies that used common variants in <jats:italic>PNPLA3</jats:italic>, <jats:italic>TM6SF2</jats:italic> and <jats:italic>GCKR</jats:italic> as instruments to investigate the relationship between NAFLD and coronary artery disease (CAD) have reported contrasting results. Variants in <jats:italic>PNPLA3</jats:italic> and <jats:italic>TM6SF2</jats:italic> were found to protect against CAD, whereas variants in <jats:italic>GCKR</jats:italic> were positively associated with CAD. Since all three genes have been associated with non-alcoholic steatohepatitis, the second stage of NAFLD, the question of whether low-grade inflammation is an important mediator of the relationship between NAFLD and CAD arises. In contrast, the differential effects of these genes on plasma lipids (i.e. lipid-lowering for <jats:italic>PNPLA3</jats:italic> and <jats:italic>TM6SF2</jats:italic>, and lipid-raising for <jats:italic>GCKR</jats:italic>) strongly suggest that plasma lipids account for their differential effects on CAD risk. This concept has recently been confirmed in an extended set of 12 NAFLD susceptibility genes. From these studies it appears that plasma lipids are an important mediator between NAFLD and CVD risk. These findings have important clinical implications, particularly for the design of anti-NAFLD drugs that also affect lipid metabolism.</jats:p>