Cardiovascular risk factors and systemic endothelial function in patients with cirrhosis

Area of Science:

• Cardiology
• Hepatology
• Vascular Biology

Background:

• Cardiovascular risk factors (CVRF) are known to cause systemic endothelial dysfunction.
• It has been hypothesized that cirrhosis patients have low cardiovascular risk and enhanced systemic endothelial function.
• No prospective studies have investigated the relationship between cardiovascular risk and systemic endothelial function in cirrhosis.

Purpose of the Study:

• To prospectively evaluate the relationship between cardiovascular risk and systemic endothelial function in patients with cirrhosis.
• To determine the prevalence of systemic endothelial dysfunction in cirrhosis.
• To explore factors associated with endothelial dysfunction in this population.

Main Methods:

• 47 cirrhosis patients (median Child-Pugh score 8) were assessed for CVRF, 10-year global cardiovascular risk (Framingham score), and carotid plaques.
• Systemic endothelial function was non-invasively measured using brachial artery flow-mediated dilatation (FMD) via ultrasound, with FMD <10% defining dysfunction.
• Laboratory parameters, hepatic and systemic hemodynamics were also evaluated.

Main Results:

• Cardiovascular risk was not uniformly low; 9% had high risk, and 40% had moderately high risk.
• Systemic endothelial dysfunction (low FMD) was present in 53% of patients and increased with cardiovascular risk (P=0.039).
• Endothelial function (FMD) improved with advanced liver disease severity (Child-Pugh/MELD score) and inflammation markers, suggesting liver failure attenuated dysfunction.

Conclusions:

• Cardiovascular risk is a significant issue in cirrhosis patients, contrary to previous assumptions.
• Systemic endothelial dysfunction is prevalent in cirrhosis and is associated with cardiovascular risk.
• While cardiovascular risk impairs endothelial function, advanced liver failure may offer some protection against endothelial dysfunction.