Research from JAMA Internal Medicine — Treatment With Multiple Blood Pressure Medications, Achieved Blood Pressure, and Mortality in Older Nursing Home Residents — The PARTAGE Study

The relationship between non-alcoholic fatty liver disease (NAFLD) and atrial fibrillation (AF) in type 2 diabetes is currently unknown. We examined the relationship between NAFLD and risk of incident AF in people with type 2 diabetes. We prospectively followed for 10 years a random sample of 400 patients with type 2 diabetes, who were free from AF at baseline. A standard 12-lead electrocardiogram was undertaken annually and a diagnosis of incident AF was confirmed in affected participants by a single cardiologist. At baseline, NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other liver diseases. During the 10 years of follow-up, there were 42 (10.5%) incident AF cases. NAFLD was associated with an increased risk of incident AF (odds ratio [OR] 4.49, 95% CI 1.6–12.9, p<0.005). Adjustments for age, sex, hypertension and electrocardiographic features (left ventricular hypertrophy and PR interval) did not attenuate the association between NAFLD and incident AF (adjusted-OR 6.38, 95% CI 1.7–24.2, p = 0.005). Further adjustment for variables that were included in the 10-year Framingham Heart Study-derived AF risk score did not appreciably weaken this association. Other independent predictors of AF were older age, longer PR interval and left ventricular hypertrophy. Our results indicate that ultrasound-diagnosed NAFLD is strongly associated with an increased incidence of AF in patients with type 2 diabetes even after adjustment for important clinical risk factors for AF.

Background: Patients with moderate to severe chronic plaque psoriasis have a higher prevalence of cardiovascular risk factors and atherosclerosis. Arterial stiffness is a measure of endothelial dysfunction and an independent predictor of cardiovascular events. Objectives: To investigate whether chronic plaque psoriasis is associated with an increased arterial stiffness. Methods: A cross-sectional study on 39 adult patients with moderate to severe chronic plaque psoriasis and 38 control patients with skin diseases other than psoriasis was conducted. Arterial stiffness was assessed by carotid-femoral and carotid-radial pulse wave velocity (PWVcf, PWVcr). Results: PWVcf was significantly higher in patients with psoriasis than in controls (means ± SD; 8.88 ± 1.96 vs. 7.57 ± 1.34 m/s; p = 0.001). Difference was still significant after adjustment for age, gender, smoking status, hypertension and body mass index (8.78 ± 1.98 vs. 7.78 ± 2.0 m/s; p = 0.03). There was a positive correlation between PWVcf and years of psoriasis duration (r = 0.58; p = 0.0001), but not with disease severity. Conclusion: Moderate to severe chronic plaque psoriasis may be independently associated with increased arterial stiffness. Psoriasis duration could be a risk factor for arterial stiffness and atherosclerosis.