Cardiovascular disease in cirrhosis - A point-prevalence study in relationto glucose tolerance

OBJECTIVE: Impaired glucose tolerance or diabetes are frequently observed i n cirrhosis. Overt diabetes was reported to affect long term survival of ci rrhotic patients by increasing the risk of hepatocellular failure, without increasing the risk of diabetes-associated cardiovascular events. METHODS: We evaluated the prevalence of cardiovascular disease in 122 patie nts with cirrhosis, subdivided according to their glucose tolerance. The fo llowing parameters were considered: arterial pressure, peripheral vascular disease (ankle to brachial pressure ratio), ischemic heart disease, microal buminuria, retinopathy. The prevalence of abnormal findings was compared wi th that observed in 60 randomly selected patients with non-insulin-dependen t diabetes and in 40 controls. RESULTS: Noninsulin-dependent diabetic patients and patients with cirrhosis and diabetes were comparable for age, metabolic control, and smoking habit s; the duration of diabetes was 5 yr longer for noninsulin-dependent diabet es. In cirrhosis, the prevalence of micro- and peripheral macroangiopathy, as well as coronary heart disease, was not different in relation to glucose tolerance, it was comparable to that of controls, and significantly lower than that observed in noninsulin-dependent diabetes. CONCLUSIONS: Cirrhotic patients, even in the presence of overt diabetes, ar e at low risk of cardiovascular disease. The low prevalence may be related to shorter duration of diabetic disease, also in relation to reduced life e xpectancy, as well as to liver disease-induced abnormalities protecting the cardiovascular system from atherosclerosis. (Am J Gastroenterol 1999;94:65 5-662. (C) 1999 by Am. Cell. of Gastroenterology).