Issue 42 April 2012
1. Fatty liver, Cholesterol and Heart Disease

There is ample evidence that cardiovascular disease is the most common cause of mortality in patients with NAFLD. A study from our Center at the 70th American Scientific Sessions revealed that 44.6% had elevated ALT levels with mean ALT level of 46 IU/L. Of 283 patients with elevated ALT, 86% had <2.5x upper limit of normal.

Patients with Non Alcoholic Fatty Liver Disease (NAFLD) frequently have dyslipidemia along with other features of metabolic syndrome such as obesity, diabetes mellitus, and hypertension. The dyslipidemia in NAFLD is characterized by increased serum triglycerides, increased small, dense low-density lipoprotein (LDL nontype A) particles, and low high-density lipoprotein (HDL) cholesterol.

The pathogenesis of dyslipidemia in NAFLD is likely related to hepatic overproduction of the very low-density lipoprotein particles and dysregulated clearance of lipoproteins from the circulation.

Rigorous dyslipidemia treatment plays a critical role in the overall management of patients with NAFLD. Statins are the first-line agents to treat high cholesterol and their dosage should be adjusted based on achieving therapeutic targets and tolerability. It is important to note that atorvastatin is the most effective in patients with NAFLD; furthermore, it is the only statin to show a reduced cardiovascular morbidity in patients with NAFLD

Omega-3 fatty acids are perhaps the first choice to treat hypertriglyceridemia because of their safety, tolerability, and efficacy in improving serum triglycerides, as well as their potential to improve liver disease.

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