Abstract
New evidence suggests that non-alcoholic fatty liver disease (NAFLD) has a strong multifaceted relationship with diabetes and metabolic syndrome, and is associated with increased risk of cardiovascular events, regardless of traditional risk factors, such as hypertension, diabetes, dyslipidemia, and obesity. Given the pandemic-level rise of NAFLD—in parallel with the increasing prevalence of obesity and other components of the metabolic syndrome—and its association with poor cardiovascular outcomes, the question of how to manage NAFLD properly, in order to reduce the burden of associated incident cardiovascular events, is both timely and highly relevant. This review aims to summarize the current knowledge of the association between NAFLD and cardiovascular disease, and also to discuss possible clinical strategies for cardiovascular risk assessment, as well as the spectrum of available therapeutic strategies for the prevention and treatment of NAFLD and its downstream events.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in developed countries
It is well established that non-alcoholic fatty liver disease (NAFLD) is associated with an increased prevalence of traditional CV risk factors, in particular type 2 diabetes and obesity [21], but some studies have aimed to evaluate long-term outcomes in patients with NAFLD and observed that the presence of liver disease represents a predictor of CV events, regardless of the association with traditional risk factors
Several studies have suggested a possible role of NAFLD in the development of cardiac rhythm disturbances, and a recent meta-analysis involving two cross-sectional and three cohort studies including a total of 238,129 subjects found a higher risk of atrial fibrillation (AF) in NAFLD patients than in those without liver disease, a significant heterogeneity was found among the different studies [37]
Summary
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in developed countries. Epidemiological and clinical studies have confirmed the role of NAFLD in the development of different CV manifestations, such as left ventricular dysfunction, atherosclerotic CV disease, cardiac conduction system abnormalities and ischemic stroke, suggesting that its contribution may be independent of the presence of traditional CV risk factors [3,4,5]. Despite this evidence, NAFLD is still considered as a benign condition, and clinical practice remains largely unchanged. This review aims to provide a synthesis and critical evaluation of the literature relevant to the postulated continuum between NAFLD and CV disease
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