To investigate the possible role of non-invasive fibrosis scoring systems for detecting high-risk plaque among patients with non-alcoholic fatty liver disease (NAFLD).

A total of 477 consecutive asymptomatic subjects underwent a health checkup including coronary computed tomography angiography (CTA) and abdominal ultrasonography. Fatty liver was evaluated using ultrasonography, and the NAFLD fibrosis score (NFS) was calculated. Coronary stenosis and plaque were evaluated using coronary CTA.

Of the study population, 223 had NAFLD. Among the NAFLD patients, high-risk coronary plaque was more frequent in patients with high or intermediate NFS than those with low NFS (62.5% versus 24.0%, P<0.001). The adjusted odds ratio with 95% confidence interval of high-risk plaque was 3.24 (1.11-9.40) for the highest versus lowest quartile of NFS (P=0.016). Among those without NAFLD, NFS was not associated with high-risk coronary plaque (C-statistic with NFS versus without NFS, 0.766 versus 0.764, P=0.715). Adding NFS to the traditional cardiovascular disease (CVD) risk model increased the C-statistics by 0.679 to 0.739 (P=0.031).

There was an independent association of NFS with high-risk coronary plaque in patients with NAFLD, suggesting its potential use to optimize management of patients with NAFLD.

Atherosclerosis; Coronary artery disease; Non-alcoholic fatty liver disease; Non-invasive fibrosis score