{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T15:05:03Z","timestamp":1779894303567,"version":"3.53.1"},"reference-count":35,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,3,21]],"date-time":"2016-03-21T00:00:00Z","timestamp":1458518400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2016,6]]},"abstract":"ABSTRACT<\/jats:title>Background<\/jats:title>Nonalcoholic fatty liver disease, insulin resistance (IR<\/jats:styled-content>), and obesity frequently coexist with type 2 diabetes mellitus (DM<\/jats:styled-content>), but it is uncertain whether these risk factors for vascular disease contribute to a change in atherosclerosis over time, independently of DM<\/jats:styled-content> status.<\/jats:p><\/jats:sec>Hypothesis<\/jats:title>We hypothesized that the combination of fatty liver, IR<\/jats:styled-content>, and obesity would be associated with an increase in coronary artery calcium (CAC<\/jats:styled-content>) score over time, independently of DM<\/jats:styled-content> status, other cardiovascular risk factors, and medications.<\/jats:p><\/jats:sec>Methods<\/jats:title>Data were analyzed from a South Korean occupational cohort of 2175 people. The outcome was increase in cardiac computed tomography CAC<\/jats:styled-content> score between baseline and follow\u2010up. Insulin resistance was defined by homeostatic model assessment of insulin resistance (HOMA\u2010IR<\/jats:styled-content>) \u226575th percentile and fatty liver by ultrasound.<\/jats:p><\/jats:sec>Results<\/jats:title>In 592 (27.2%) participants, CAC<\/jats:styled-content> score increased from baseline (mean \u00b1 SD<\/jats:styled-content>; mean age at baseline, 44.8 \u00b1 5.5 years); and in 1583 subjects, CAC<\/jats:styled-content> did not change or improved during follow\u2010up (mean age, 41.6 \u00b1 5.6 years). Diabetes mellitus, HOMA\u2010IR<\/jats:styled-content>, fatty liver, and obesity prevalence were all higher (all P<\/jats:italic> < 0.001) in participants whose CAC<\/jats:styled-content> score increased from baseline. Adjusting for DM<\/jats:styled-content> and potential confounders, the combination of IR<\/jats:styled-content>, obesity, and fatty liver was independently associated with increase in CAC<\/jats:styled-content> score over time (hazard ratio: 2.46, 95% confidence interval: 1.50\u20104.03).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The combination of fatty liver, IR<\/jats:styled-content>, and obesity is associated with progression of atherosclerosis over time independently of DM<\/jats:styled-content>, cardiovascular risk factors, and all medications for cardiovascular disease and DM<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.22529","type":"journal-article","created":{"date-parts":[[2016,3,21]],"date-time":"2016-03-21T08:58:39Z","timestamp":1458550719000},"page":"321-328","source":"Crossref","is-referenced-by-count":20,"title":["Fatty Liver, Insulin Resistance, and Obesity: Relationships With Increase in Coronary Artery Calcium Over Time"],"prefix":"10.1002","volume":"39","author":[{"given":"Ki\u2010Chul","family":"Sung","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungho","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong\u2010Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Ho","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Sun","family":"Cheong","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah H.","family":"Wild","sequence":"additional","affiliation":[{"name":"Centre for Population Health Sciences University of Edinburgh Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D.","family":"Byrne","sequence":"additional","affiliation":[{"name":"Nutrition and Metabolism Unit Southampton General Hospital (University of Southampton) and Southampton National Institute for Health Research Biomedical Research Centre Southampton United 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