Relationship between liver cirrhosis and arteriosclerosis: Evaluation by pulse wave velocity, carotid arterial echotomography and autonomic nervous activity

Background: It has been reported that patients with liver cirrhosis (LC) rarely suffer complications from arteriosclerotic disorders such as coronary artery disease. However, recent studies have reported that the measurement of pulse wave velocity (PWV) facilitates objective evaluation of the severity of arteriosclerosis, suggesting a relationship between LC and arteriosclerosis. Objective: In the present study, we evaluated the relationship among the PWV augmentation index (AI), and stage of LC from the perspective of urine levels of NO metabolites (NO2 and NO3) and autonomic nervous function. Methods: Forty elderly LC patients who were 65 years or older (LC group) were classified into the following three groups based on the Child's classification of LC: LC-A group (15 patients with Child A); LC-B group (15 patients with Child B); and LC-C group (10 patients with Child C). The results from these LC subgroups were compared to those of 25 healthy volunteers (N group). The PWV and AI were measured using a blood pressure and pulse wave monitoring device. Furthermore, we measured the urine levels of NO2 and NO3 and autonomic nervous activity and evaluated these by the measurements and by spectrum analysis of heart rate variability. In addition, the intima media thickness (IMT) in the carotid artery was measured by common carotid artery echotomography in each group. Results: The IMT increased with the stage of LC. Both the HF powers significantly decreased and LF : HF ratio increased in the LC group as the Child stage of LC advanced. The AI and PWV were significantly higher in the LC-A and LC-B groups than in the N group. However, PWV and AI of the LC-C group were measured to a low value because the urine levels of NO2 and NO3 were significantly increased as the Child stage of LC advanced, and arteriosclerotic diagnosis seems to tend to be reduced in LC-C patients. Conclusions: The increase in PWV and Al of LC-A and LC-B might suggest a relation ship between advances of LC and arteriosclerosis. However, the hyperdynamic state in LC from the results of heart rate variability analysis, which is induced by NO production with the progression of the stage of LC, might have influenced the PWV and AI.