Cardiovascular Risk in Non-Alcoholic Fatty Liver Disease: Mechanisms and Therapeutic Implications

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.

Relationship between Heart Disease and Liver Disease: A Two-Way Street

“…The precise mechanisms linking NAFLD with cardiac complications are poorly understood. However, several pathophysiological mechanisms have been postulated to be involved such as insulin resistance, visceral adiposity, subclinical inflammation, dyslipidemia, and oxidative stress (Figure 1e) [96].…”

“…Bariatric surgery represents a recommended choice for morbidly obese individualsif lifestyle modifications and pharmacological approach have not yielded long-term success. It provides cardiovascular benefits in terms of reducing overall mortality by improving hepatic inflammation, metabolic syndrome components, and cardiac morphology [96,117].…”

Direct Oral Anticoagulants in Patients with Liver Disease in the Era of Non-Alcoholic Fatty Liver Disease Global Epidemic: A Narrative Review

“…Beyond its inherent liverrelated morbidity and mortality, NAFLD also has a strong mutual, bi-directional relationship with type 2 diabetes (T2D)/metabolic syndrome (MetS) [40,41]. Moreover, it is associated with an increased incidence and prevalence of fatal and non-fatal cardiovascular disease (CVD) events, mainly coronary heart disease (CHD), independently of classical cardiovascular risk factors [42][43][44][45]. Interestingly, several observational studies reported an association between NAFLD and increased risk of AF in patients with and without T2D, after adjustment for multiple potential confounders [46].…”

Die nicht-alkoholische Fettlebererkrankung bei Kindern und Jugendlichen – ein Update

“…Bei Männern stellt sie nach der ASH die zweithäufigste Ursache dar [14]. Darüber hinaus haben Studien wiederholt gezeigt, dass die NASH als unabhängiger Risikofaktor für kardiovaskuläre Ereignisse gilt und diese zugleich die häufigste Todesursache bei Patienten mit NAFLD ist [15,16]. NAFLD-Patienten haben zudem ein erhöhtes Risiko, ein extrahepatisches Karzinom (v.a.…”