Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 8, 2017; 9(19): 857-866
Published online Jul 8, 2017. doi: 10.4254/wjh.v9.i19.857
Is hepatic steatosis associated with left ventricular mass index increase in the general population?
Katharina Piontek, Carsten O Schmidt, Sebastian E Baumeister, Markus M Lerch, Julia Mayerle, Marcus Dörr, Stephan B Felix, Henry Völzke
Katharina Piontek, Institute for Medical Psychology, University Medicine Greifswald, 17489 Greifswald, Germany
Katharina Piontek, Carsten O Schmidt, Sebastian E Baumeister, Henry Völzke, Institute for Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany
Markus M Lerch, Julia Mayerle, Department of Medicine A, University Medicine Greifswald, 17489 Greifswald, Germany
Marcus Dörr, Stephan B Felix, Department of Cardiology, University Medicine Greifswald, 17489 Greifswald, Germany
Marcus Dörr, Stephan B Felix, Henry Völzke, German Centre for Cardiovascular Research, Partner site Greifswald, 17489 Greifswald, Germany
Author contributions: Piontek K and Schmidt CO contributed equally to this work; Völzke H designed the research; Schmidt CO analysed the data; Piontek K wrote the paper; Baumeister SE, Lerch MM, Mayerle J, Dörr M and Felix SB contributed to writing the paper; all authors read and approved the final manuscript.
Supported by Bundesministerium für Bildung und Forschung (BMBF), No. 01 ZZ 0103.
Institutional review board statement: The study protocol was approved by the Ethics Committee of the University of Greifswald. The study was monitored by a review board of independent scientists.
Informed consent statement: All study participants provided informed consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: Statistical code is available from the corresponding author. The data set can be requested from the Institute for Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany, under consideration of local data protection formalities.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Katharina Piontek, Dipl.-Psych., Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17489 Greifswald, Germany. katharina.piontek@uni-greifswald.de
Telephone: +49-3834-865696
Received: September 20, 2016
Peer-review started: September 24, 2016
First decision: November 21, 2016
Revised: March 20, 2017
Accepted: April 18, 2017
Article in press: April 20, 2017
Published online: July 8, 2017
Abstract
AIM

To investigate the association between hepatic steatosis and change in left ventricular mass index (LVMI) over five years, and examine whether systolic and diastolic blood pressures are mediators of the association between hepatic steatosis and LVMI using a general population sample.

METHODS

We analyzed data from the Study of Health in Pomerania. The study population comprised 1298 individuals aged 45 to 81 years. Hepatic steatosis was defined as the presence of a hyperechogenic pattern of the liver together with elevated serum alanine transferase levels. Left ventricular mass was determined echocardiographically and indexed to height2.7. Path analyses were conducted to differentiate direct and indirect paths from hepatic steatosis to LVMI encompassing systolic and diastolic blood pressure as potential mediating variables.

RESULTS

Hepatic steatosis was a significant predictor for all measured echocardiographic characteristics at baseline. Path analyses revealed that the association of hepatic steatosis with LVMI change after five years was negligibly small (β = -0.12, s.e. = 0.21, P = 0.55). Systolic blood pressure at baseline was inversely associated with LVMI change (β = -0.09, s.e. = 0.03, P < 0.01), while no association between diastolic blood pressure at baseline and LVMI change was evident (β = 0.03, s.e. = 0.05, P = 0.56). The effect of the indirect path from hepatic steatosis to LVMI via systolic baseline blood pressure was small (β = -0.20, s.e. = 0.10, P = 0.07). No indirect effect was observed for the path via diastolic baseline blood pressure (β = 0.03, s.e. = 0.06, P = 0.60). Similar associations were observed in the subgroup of individuals not receiving beta-blockers, calcium channel blockers, or drugs acting on the renin-angiotensin system.

CONCLUSION

Baseline associations between hepatic steatosis and LVMI do not extend to associations with LVMI change after five years. More studies are needed to study the longitudinal effects of hepatic steatosis on LVMI.

Keywords: Hepatic steatosis, Left ventricular mass index, Blood pressure, General Population, Study of Health in Pomerania

Core tip: Data regarding the association between hepatic steatosis and left ventricular remodeling are limited and previous studies revealed conflicting results. In the present study, hepatic steatosis as defined by liver hyperechogenicity and increased alanine transferase levels was a significant predictor for all measured echocardiographic characteristics at baseline. In contrast, hepatic steatosis was not a predictor of relevance for left ventricular mass index (LVMI) change. Systolic and diastolic blood pressures did not mediate the association between hepatic steatosis and LVMI.