Effects of treatment of non-alcoholic fatty liver disease on heart failure with preserved ejection fraction

Abstract

In the past few decades, non-alcoholic fatty liver disease (NAFLD) and heart failure with preserved ejection fraction (HFpEF) have become the most common chronic liver disease and the main form of heart failure (HF), respectively. NAFLD is closely associated with HFpEF by sharing common risk factors and/or by boosting systemic inflammation, releasing other secretory factors, and having an expansion of epicardial adipose tissue (EAT). Therefore, the treatments of NAFLD may also affect the development and prognosis of HFpEF. However, no specific drugs for NAFLD have been approved by the Food and Drug Administration (FDA) and some non-specific treatments for NAFLD are applied in the clinic. Currently, the treatments of NAFLD can be divided into non-pharmacological and pharmacological treatments. Non-pharmacological treatments mainly include dietary intervention, weight loss by exercise, caloric restriction, and bariatric surgery. Pharmacological treatments mainly include administering statins, thiazolidinediones, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, and metformin. This review will mainly focus on analyzing how these treatments may affect the development and prognosis of HFpEF.

Hypoglycemic Drugs in Patients with Diabetes Mellitus and Heart Failure: A Narrative Review

“…Of note, a recent RCT with 73 patients with T2DM and nonalcoholic fatty liver disease (NAFLD) found that pioglitazone improves global longitudinal strain (GLS), and NAFLD is a disease which is associated with an increased risk of developing HFpEF [ 55 ]. Although pioglitazone is recommended for patients with T2DM and NAFLD and based on animal model trials, reduces LV fibrosis, the potential role of this agent in HFpEF needs further investigation, especially because of the increase in the incidence of HF [ 56 ].…”

Systemic impacts of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) on heart, muscle, and kidney related diseases

“…This complex relationship between MASH and cardiovascular morbidity is underscored by shared and interlinked risk factors, including but not limited to IR, T2D, hypertension, dyslipidaemia, metabolic syndrome, and notably, liver fibrosis ( Houghton et al, 2019 ; Ismaiel and Dumitrascu, 2019 ). Furthermore, the relationship between the likelihood of developing cardiovascular abnormalities and the severity of hepatic fibrosis in MASH is strongly correlated ( Yang et al, 2022 ; Wegermann et al, 2023 ).…”

“…The complex link between coronary microvascular dysfunction and HFpEF development in MASH patients is of growing interest. HFpEF, featuring heart failure symptoms alongside normal ejection fraction, is increasingly common in those with metabolic syndrome and MASH, primarily due to diastolic dysfunction and altered filling pressures ( Yang et al, 2022 ; Wegermann et al, 2023 ). This condition constitutes a significant portion of heart failure cases, notably in MASH-related metabolic derangements.…”

Non-alcoholic fatty liver disease is associated with a worse prognosis in patients with heart failure: A pool analysis

“…Recent studies suggested that NAFLD was associated with an increased risk of HF in patients, which may be caused by insulin resistance, impaired glucolipid metabolism, chronic inflammatory activation, increased renin-angiotensin-aldosterone and sympathetic nervous system activity, or the altered expression of adipokines and gut microbiota ( 9 , 10 ). Furthermore, the prevalence of NAFLD in HF patients is progressively increasing ( 11 – 13 ). However, it is still unclear whether coexisting NAFLD leads to a poorer prognosis in HF patients.…”