Role of Transient Elastography Through Controlled Attenuation Parameter (CAP) in Assessment of The Stratification of Subclinical Cardiovascular Diseases Risk in NAFLD Patients

Background: Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized as a multisystem disease with significant cardiovascular implications. Controlled Attenuation Parameter (CAP), a component of transient elastography, provides a non-invasive estimate of liver steatosis. Aim of work: This study aimed to evaluate the association between CAP-measured hepatic steatosis and subclinical cardiovascular abnormalities in NAFLD patients. Methods: This cross-sectional study included 100 NAFLD patients aged 18-50 years without known cardiovascular disease (CVD), diabetes, or obesity (BMI >30 kg/m²). All patients underwent clinical evaluation, laboratory testing, transient elastography with CAP measurement, echocardiography including speckle-tracking for global longitudinal strain (GLS), electrocardiography (ECG), and coronary artery calcium (CAC) scoring by CT. Correlations between CAP and metabolic and cardiovascular parameters were analyzed. Results: The mean CAP score was 269.5 ± 21.5 dB/m. Higher CAP scores were significantly associated with elevated liver enzymes, cholesterol, triglycerides, and fasting blood glucose, and inversely associated with HDL and serum albumin (p<0.001). CAP also demonstrated a strong positive correlation with CAC score (r=0.85), left ventricular mass (r=0.81), left atrium volume (r=0.74), and impaired GLS (r=0.72) (all p<0.001), indicating early cardiac remodeling and vascular calcification in patients with increased hepatic steatosis. Conclusion: Hepatic steatosis using CAP is significantly associated with subclinical cardiovascular disease markers in NAFLD patients. CAP may be a valuable tool for early cardiovascular risk stratification in this population, highlighting the need for integrated hepatocardiac care in practice.