Liver Fibrosis, Sarcopenia May Contribute to Vascular Dysfunction, Arterial Stiffness in Type 2 Diabetes

In patients with type 2 diabetes (T2D), the cooccurrence of liver fibrosis (LF) and sarcopenia may synergistically contribute to vascular damage and arterial stiffness, according to study findings published in IJC Heart & Vasculature.

Researchers conducted a cross-sectional study, enrolling 115 patients (N=115) with T2D who were referred for glycemic control optimization consultation at the Dokkyo Medical University Hospital in Japan. The primary outcomes were endothelial dysfunction as measured by reactive hyperemia index (RHI) and arterial stiffness as measured by cardio-ankle vascular index (CAVI). LF was defined by liver stiffness measurement (LSM) greater than or equal to 8.0 kPa, sarcopenia as the ratio of appendicular skeletal muscle mass to body mass of less than 0.789 for men and less than 0.512 for women, endothelial dysfunction as RHI less than 1.67, and arterial stiffness as CAVI greater than 9.0.

The patient population comprised 70 men and 45 women, with a mean age of 59.0±13.8 years, BMI was 26.6±4.7 kg/m², glycated hemoglobin was 9.2%±2.2%, RHI was 1.72±0.42, and CAVI was 8.85±1.45.

Patients were found to have no LF or sarcopenia (n=45), LF and no sarcopenia (n=25), no LF and sarcopenia (n=23), and both LF and sarcopenia (n=14). Patients with LF had significantly lower RHI (P =.0218) and higher CAVI (P =.0215), and those with sarcopenia had significantly lower RHI (P =.0150) and similar CAVI as patients without sarcopenia. Patients with both conditions had higher BMI, total fat mass, and urinary albumin to creatinine ratio.

In the multiple logistic regression analysis, the ratio of appendicular skeletal muscle mass to body mass (β, -9.752; P =.026) and high-density lipoprotein cholesterol (β, 0.053; P =.035) was a significant predictor for endothelial dysfunction and arterial stiffness.

In the receiver operating characteristic (ROC) curve analysis, LSM (area under the curve [AUC], 0.682; P =.006) and high-density lipoprotein cholesterol (AUC, 0.636; P =.041) were predictors for the composite outcome.

Study limitations included the cross-sectional design, which did not allow for evaluating causal relationships, and a small number of study participants.

The researchers concluded that, “liver fibrosis and sarcopenia are independently associated with endothelial dysfunction and arterial stiffness in patients with [T2D]. Furthermore, coexistence of liver fibrosis and sarcopenia may synergistically lead to vascular damage and thus contribute to the high risk of cardiovascular disease in people with [T2D].”

Reference

Jojima T, Kurai H, Tanuma D, et al. Synergistic effects of liver fibrosis and sarcopenia on endothelial dysfunction and arterial stiffness in patients with type 2 diabetes. Int J Cardiol Heart Vasc. Published online June 16, 2022. doi:10.1016/j.ijcha.2022.101071