Nonalcoholic fatty liver disease and cardiovascular concerns: The time for hepatologist and cardiologist close collaboration

Table 1 Screening of cardiovascular risk in asymptomatic individuals (based on References[6,7])

Class of recommendation	Screening tools	Level of evidence
Class I	Risk prediction by scores and family history	B
Class IIa	hs-CRP in men > 50 yr or women > 60 yr of age without other risk factors, to select for statin therapy	B
	ECG at rest if there are risk factors such as diabetes/hypertension	C
	Carotid intima-media thickness if intermediate-risk	B
	Coronary calcium if intermediate-risk1	B
Class IIb	HbA1c if asymptomatic adults without a diagnosis of diabetes
	hs-CRP if asymptomatic intermediate-risk	B
	ECG at rest without risk factors	C
	Exercise ECG if intermediate risk, including sedentary adults considering vigorous exercise	B
	Resting echocardiography if hypertension (to look for left ventricular hypertrophy)	B
	Myocardial perfusion imaging for asymptomatic adults with diabetes, strong family history, or high risk in previous investigations	C
	Coronary calcium if low-intermediate risk, not recommended for low risk	B
Class III	Genetic prediction	B
	Lipoproteins, apolipoproteins, particle size/density beyond a standard fasting lipid profile	B
	Peripheral arterial flow-mediated dilation	B
	Stress echocardiography if low/intermediate-risk (primarily used for symptomatic patients, to know prognosis in a known coronary artery disease)	C
	Myocardial perfusion imaging if low/intermediate-risk diabetes, strong family history, or high risk in previous investigations	C
	CT coronary angiography	C
	MRI of plaque	C

¹Generally not present in men < 40 yr or women < 50 yr of age, the ideal score is 0, no ideal cutoff, risk increases with the increasing score, adds to the prediction of Framingham risk score.

CT: Computed tomography; ECG: Electrocardiography; hs-CRP: High-sensitivity C-reactive protein; MRI: Magnetic resonance imaging.