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Cardio Diabetes Medicine 2017 475

NAFLD and CVD - Importance and Therapies

Dr. R. Ramasubramanian. DNB, DM (Gastro)
Professor of Medical Gastroenterology,
Government Thoothukudi Medical College, Thoothukudi.

Introduction: achieved in 6-8 months.
Non-alcoholic fatty liver disease (NAFLD) is often b.Treatment of Dyslipidemia:
associated with insulin resistance and is strongly
associated with type 2 diabetes mellitus and Guidelines set forth by the NCEP Adult Treatment
obesity. In addition to being at risk for nonalcoholic Panel III provide guidance on which groups should
steatohepatitis, cirrhosis and its complications, be targeted for lipid-lowering therapy and outlines
NAFLD patients are also at higher risk of treatment goals. Most attractive group of lipid-
cardiovascular diseases (CVD), including coronary lowering agents for cardiovascular protection are
heart disease and stroke. NAFLD confers increased the statins. In addition to a major effect in lowering
cardiovascular disease risk independent of traditional LDL, they have modest effects on increasing HDL
cardiovascular risk factors and metabolic syndrome. and lowering serum triglycerides, as well as non-
Close followup of patients with NAFLD may be cholesterol-lowering effects on vascular endothelium
indicated to prevent major vascular events. by inducing endothelial nitric oxide synthase.
Mechanism: Statin hepatotoxicity has not been shown to be of
increased risk in NAFLD. Statins can be safely used
Several mechanisms have been postulated for in NAFLD and NASH, and routine liver enzyme
development of accelerated atherosclerosis monitoring need not be done. Statins can be safely
in patients with NAFLD, including genetic used in patients with decompensated liver disease.
predisposition, insulin resistance and atherogenic There is always concern for using high dose statins
dyslipidemia, oxidative stress, chronic inflammation, in patients with elevated liver enzymes; in such
reduced levels of the adiponectin and altered circumstances adding ezetimibe has a synergistic
production of pro and anticoagulant factors. effect with statins.

Management of cardiovascular disease risk Triglyceride elevations are also a risk factor
in NAFLD: for cardiovascular disease. Attempts to reduce
raised serum triglyceride levels center around
a. Lifestyle Modification: weight reduction, improving insulin resistance
(physical activity) and diabetic control, with use of
All patients with NAFLD, irrespective of their body
weight, should be advised lifestyle modifications polyunsaturated fatty acids (fish oil) as the first-line
in the form of regular exercise. Those who are pharmacologic approach.
overweight or obese are advised weight reduction. NAFLD and Diabetes Mellitus
An exercise regimen should aim to achieve a target
heart rate of 60%-70% of maximal heart rate through DM is associated with an increased risk of CVD.
exercises such as brisk walking, jogging, or other Because DM is highly prevalent among individuals with
aerobic exercises for at least 30 min, 5 d per week. NAFLD, comprehensive management is essential for
Initial weight reduction in patients who are overweight CVD risk reduction. Primary and secondary prevention
or obese should be 10% of the body weight to be of CVD events in individuals with DM should focus
on multifactorial risk reduction, including treatment

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