Non-alcoholic fatty liver disease (NAFLD) is one of the most common forms of chronic liver disease in the Western world. There is a close association with the metabolic syndrome and NAFLD is considered to be the hepatic manifestation of the metabolic syndrome. The components of the metabolic syndrome include hypertension, obesity and insulin resistance which are well established cardiovascular risk factors. The mortality rate of NAFLD patients from myocardial infarction is higher than that in the general United States population and there is also an increased risk of nonfatal cardiovascular events. This article reviews the cardiovascular complications associated with NAFLD. In order to provide comprehensive care of NAFLD patients, physicians need to be aware of, and search for, the cardiac morbidity associated with NAFLD. Core tip: Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome. Due to the overlapping cardiovascular risk factors in the metabolic syndrome, there are cardiovascular consequences linked to the presence of NAFLD in a patient. We review these complications and also a less well appreciated complication of diastolic dysfunction that is intimately associated with NAFLD. Physicians looking after NAFLD patients need to be aware of these complications and actively search for and treat them.Azzam H, Malnick S. Non-alcoholic fatty liver disease -the heart of the matter. World J Hepatol 2015; 7(10):