Background: Non-alcoholic steatohepatitis (NASH) is linked with metabolic syndrome and is associated with increased cardiovascular risk. NASH is characterized by steatosis, inflammation, and fibrosis and may progress to cirrhosis. Aortic stiffness and wave reflections are independent markers and predictors of cardiovascular risk. We investigated the arterial stiffness in NASH patients with or without cirrhosis.

Methods: The study population consisted of 34 subjects (mean age: 62.2 ± 10.2 yrs, 9M/25F). In particular, 19 had bioptical evidence of NASH, cirrhosis was present in 7 of them and 12 NASH patients had no bioptical or biochemical evidence of cirrhosis. 14 subjects without liver disease were recruited in this study. The three groups did not differ in classical risk factors. Carotid-femoral pulse wave velocity (PWV) was measured as index of aortic stiffness. Augmentation index (AIx) of the central (aortic) pressure waveform was measured as an index of wave reflections.

Results: PWV was significantly increased in NASH patients without cirrhosis compared to controls (9.3 ± 1.6 vs 7.7 ± 1.3 m/s, p<0.05), but cirrhotic patients had significantly reduced PWV compared to NASH patients without cirrhosis (7.2 ±1.2 vs 9.3 ± 1.6 m/s, p<0.05), while AIx did not differ.

Conclusions: The transition of NASH to cirrhosis is followed by the paradoxical improvement of the stiffen arteries, which may be explained from the changes in neurohormonal regulatory systems, kidney function and cardiovascular system, such as the decreased overall systemic vascular resistance and the reduced arterial blood pressure.