Introduction:
Nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for coronary artery disease; moreover, it increases systemic atherosclerotic burden by inducing the overexpression of inflammatory mediators, promoting endothelial damage, and impairing blood pressure regulation.

Aim:
Aim of this work was to evaluate whether a standardized evaluation of NAFLD improves cardiovascular risk assessment recognizing subclinical atherosclerosis in lower cardiovascular risk.

Material and methods:
We investigated NAFLD occurrence and severity, carotid and femoral intima-media-thickness (IMT) and vascular stiffness by ultrasound technique, endothelial function by peripheral-arterial-tonometry, lipid profile and inflammatory markers in 220 subjects (100 men, 120 women; 45.42 ± 13.22 years old), without history of cardiovascular event, diabetes, liver infection, alcohol consumption, systemic diseases, and the use of drugs causing liver damage. NAFLD was evaluated, graded according to an eight-point scoring semi-quantitative severity score.

Results and discussion:
At univariate logistic analysis, NAFLD ≥ 3 score was significantly associated with pathological IMT, augmentation index, pulsewave-velocity at carotids and femoral arteries, and endothelial dysfunction, and this association was confirmed after adjustment for European Society of Cardiology Systematic Coronary Risk Evaluation (ESC SCORE) at multivariate analyses. Moreover, high sensitivity C-reactive protein levels were significantly higher in patients with at least 3 point steatosis, in comparison to the others. Receiver operating characteristic (ROC) curve analysis for NAFLD showed a significant higher area under curve for the detection of both early atherosclerotic burden and vascular stiffness, in comparison to ROC curve of ESC SCORE.

Conclusions:
According to our findings a NAFLD ≥ 3 score was able to screen a subgroup with widespread morphological vascular damage and endothelial dysfunction in a primary prevention population.