Cardiovascular Implications of Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum from simple steatosis to nonalcoholic steatohepatitis (NASH) and fibrosis, affecting approximately one quarter of adults worldwide. Beyond its hepatic sequelae, NAFLD confers a heightened risk of cardiovascular disease that often exceeds liver‐related morbidity. Insulin resistance, dyslipidaemia, systemic inflammation and endothelial dysfunction act in concert to promote atherogenesis, arterial stiffness and subclinical myocardial remodelling. Patients with NAFLD exhibit increased carotid intima‐media thickness, impaired flow‐mediated dilation and elevated pulse wave velocity, signalling early vascular injury. At the cardiac level, concentric remodelling, left ventricular diastolic dysfunction and myocardial fibrosis have been observed even in the absence of overt heart failure. Genetic predisposition and metabolic comorbidities, such as type 2 diabetes and obesity, further amplify this cardiovascular burden. Recognition of NAFLD as an independent risk factor underscores the need for integrated cardiovascular risk assessment and multidisciplinary management.

Research from Nature Portfolio

A prospective study of patients with heart failure and preserved ejection fraction (HFpEF) found that noninvasive imaging and histology identified NAFLD in over one quarter of participants, a two-fold higher prevalence than in the general population. In those with steatosis, almost half displayed advanced fibrosis or cirrhosis. Diabetes and higher body mass index were independently associated with hepatic involvement, and patients with both HFpEF and NAFLD had more severe cardiac symptoms and functional limitation. These findings suggest a bidirectional interaction, in which cardiac dysfunction may exacerbate fibrogenesis in the fatty liver and, conversely, hepatic fibrosis may worsen heart failure phenotypes.

Cardiovascular Implications of Nonalcoholic Fatty Liver Disease publication trend

The graph below shows the total number of articles in cardiovascular implications of nonalcoholic fatty liver disease across all publications each year (not limited to Nature Index journals).

Technical terms

Nonalcoholic fatty liver disease (NAFLD): Accumulation of fat in hepatocytes in the absence of significant alcohol consumption, ranging from benign steatosis to inflammatory and fibrotic forms.
Nonalcoholic steatohepatitis (NASH): Subtype of NAFLD characterised by hepatocellular injury, inflammation and variable degrees of fibrosis.
Fibrosis-4 index (FIB-4): Noninvasive scoring system combining age, transaminases and platelet count to estimate the likelihood of advanced liver fibrosis.
Heart failure with preserved ejection fraction (HFpEF): Clinical syndrome of heart failure in which left ventricular ejection fraction remains normal but diastolic dysfunction leads to symptoms of congestion.
Left ventricular diastolic dysfunction: Impairment of myocardial relaxation and filling that raises intracardiac pressures despite preserved contractility.

References

1. Correlation analysis of the abdominal visceral fat area with the structure and function of the heart and liver in obesity: a prospective magnetic resonance imaging study. Cardiovascular Diabetology (2023).
2. Liver Fibrosis Assessed Via Noninvasive Tests Is Associated With Incident Heart Failure in a General Population Cohort. Clinical Gastroenterology and Hepatology (2024).
3. NASH triggers cardiometabolic HFpEF in aging mice. GeroScience (2024).
4. Cardiovascular Risk in Non-Alcoholic Fatty Liver Disease: Mechanisms and Therapeutic Implications. International Journal of Environmental Research and Public Health (2019).
5. Association of Nonalcoholic Fatty Liver Disease with Subclinical Cardiovascular Changes: A Systematic Review and Meta‐Analysis. BioMed Research International (2015).
6. Prevalence and staging of non-alcoholic fatty liver disease among patients with heart failure with preserved ejection fraction. Scientific Reports (2020).