NAFLD and cardiovascular diseases: a clinical review

Abstract

Non-alcoholic fatty liver DISEASE (NAFLD) is the most common chronic liver disease in Western countries and affects approximately 25% of the adult population. Since NAFLD is frequently associated with further metabolic comorbidities such as obesity, type 2 diabetes mellitus, or dyslipidemia, it is generally considered as the hepatic manifestation of the metabolic syndrome. In addition to its potential to cause liver-related morbidity and mortality, NAFLD is also associated with subclinical and clinical cardiovascular disease (CVD). Growing evidence indicates that patients with NAFLD are at substantial risk for the development of hypertension, coronary heart disease, cardiomyopathy, and cardiac arrhythmias, which clinically result in increased cardiovascular morbidity and mortality. The natural history of NAFLD is variable and the vast majority of patients will not progress from simple steatosis to fibrosis and end stage liver disease. However, patients with progressive forms of NAFLD, including non-alcoholic steatohepatitis (NASH) and/or advanced fibrosis, as well as NAFLD patients with concomitant types 2 diabetes are at highest risk for CVD. This review describes the underlying pathophysiological mechanisms linking NAFLD and CVD, discusses the role of NAFLD as a metabolic dysfunction associated cardiovascular risk factor, and focuses on common cardiovascular manifestations in NAFLD patients.

Diagnostic and Prognostic Biomarkers for Myocardial Infarction

“…MI is an aging-related systems disease caused by multiple genetic and environmental factors in addition to lifestyles (148,149). It is understandable that high-sensitivity cardiac troponin (hs-cTn) is the current golden standard for AMI diagnosis since it is the specific heart tissue damage product.…”

Nonalcoholic Fatty Liver Disease and Cardiovascular Diseases: The Heart of the Matter

“…Moreover, NAFLD has also been associated with endothelial dysfunction [ 97 ] as well as with unstable coronary plaques [ 98 ] explaining the high risk of ischemic events in these patients [ 3 ]. Furthermore, patients with ST segment elevation myocardial infarction (STEMI) presented higher short-term mortality and worse long-term prognostic when NAFLD was associated [ 67 ].…”

“…Most of the patients with NAFLD develop mild disease, although 20–30% of them progress to NASH [ 2 ]. Approximately 20% of the patients with NASH and progressive fibrosis will develop liver cirrhosis with an increased risk of hepatocellular carcinoma [ 3 – 5 ].…”

Nonalcoholic Fatty Liver Disease and Cardiovascular Disease: Overlapping Mechanisms

“…13,32,59,60 A recent meta-analysis of 16 observational studies reported that NAFLD patients had a 64% higher risk of developing fatal or nonfatal cardiovascular events. 60,61 Therefore, NAFLD represents an independent risk factor for increased intima media thickness irrespective of age, sex, visceral fat mass, and insulin resistance. 62 But it remains unclear if the hereof derived complications reflect common underlying risk factors or if they are directly caused by NAFLD.…”