Clin Mol Hepatol.
2022 Jan;28(1):67-76. 10.3350/cmh.2021.0202.
Cervicocerebral atherosclerosis and its hepatic and coronary risk factors in patients with liver cirrhosis
- Affiliations
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- 1Department of Gastroenterology and Hepatology, Hanyang University College of Medicine, Guri, Korea
- 2Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 3Department of Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 4Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- 5Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 6Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 7Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- KMID: 2523872
- DOI: http://doi.org/10.3350/cmh.2021.0202
Abstract
- Background/Aims
We aimed to investigate the silent atherosclerotic burden of cervicocephalic vessels in cirrhotic patients compared with the general population, as well as the relevant risk factors including coronary parameters.
Methods
This study included 993 stroke-free patients with liver cirrhosis (LC) who underwent magnetic resonance angiography (MRA) of the head and neck as a pre-liver transplant assessment and 6,099 health checkup participants who underwent MRA examination. The two cohorts were matched for cerebrovascular risk factors, and the prevalence of atherosclerosis in major intracranial and extracranial arteries was compared in 755 matched pairs. Moreover, traditional, hepatic, and coronary variables related to cerebral atherosclerosis were assessed in cirrhotic patients.
Results
Overall, intracranial atherosclerosis was significantly less prevalent in the LC group than in the matched control group (2.3% vs. 5.4%, P=0.002), whereas the prevalence of extracranial atherosclerosis was similar (4.4% vs. 5.8%, P=0.242). These results were maintained in multivariate analyses of the pooled samples, with corresponding adjusted odds ratios [ORs] of LC of 0.56 and 0.77 (95% confidence intervals [CIs], 0.36–0.88 and 0.55–1.09). In the LC group, lower platelet count was inversely correlated with intracranial atherosclerosis (adjusted OR, 0.31; 95% CI, 0.13–0.76). Coronary artery calcium (CAC) score ≥100 was the only predictive factor for both intracranial and extracranial atherosclerosis (adjusted ORs, 4.06 and 5.43, respectively).
Conclusions
LC confers protection against intracranial atherosclerosis, and thrombocytopenia may be involved in this protective effect. High CAC score could serve as a potential surrogate for cervicocerebral vascular screening in asymptomatic cirrhotic patients.
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