Non-Alcoholic Fatty Liver Disease and Cardiovascular Risk Factors

Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of hepatic steatosis not caused by excessive alcohol intake, ranging from simple fat accumulation to non-alcoholic steatohepatitis (NASH) with varying degrees of fibrosis. NAFLD is tightly linked to metabolic dysfunction, including obesity, insulin resistance and dyslipidaemia, and is considered the hepatic component of the metabolic syndrome. Beyond liver-related morbidity, mounting evidence implicates NAFLD in the development and progression of cardiovascular disease (CVD). Pathophysiological mechanisms include systemic inflammation, oxidative stress, endothelial dysfunction and altered adipokine profiles, all of which contribute to atherogenesis. Clinically, patients with NAFLD exhibit higher rates of hypertension, coronary artery disease, arrhythmias and subclinical atherosclerosis than matched controls. The global prevalence of NAFLD has risen in parallel with obesity and diabetes, posing a substantial public-health burden. Early identification of cardiovascular risk in NAFLD patients enables targeted preventive strategies, integrating lifestyle intervention and pharmacotherapy to mitigate both hepatic and cardiovascular complications.

Research from Nature Portfolio

Comprehensive meta-analyses have quantified the cardiovascular sequelae of NAFLD. One large synthesis of observational studies demonstrated that NAFLD confers a significant increase in the odds of both prevalent and incident cardiovascular events, including coronary artery disease and hypertension. Another systematic review and meta-analysis across nearly half a million individuals found that NAFLD predicts elevated all-cause mortality but does not independently increase mortality from cardiovascular disease or cancer. These foundational analyses underscore the dual risks of hepatic and extrahepatic outcomes in NAFLD and reinforce the importance of integrated risk assessment.

Non-Alcoholic Fatty Liver Disease and Cardiovascular Risk Factors publication trend

The graph below shows the total number of articles in non-alcoholic fatty liver disease and cardiovascular risk factors across all publications each year (not limited to Nature Index journals).

Technical terms

Non-alcoholic fatty liver disease (NAFLD): Accumulation of fat in hepatocytes not due to significant alcohol intake.

Non-alcoholic steatohepatitis (NASH): A progressive form of NAFLD characterised by hepatocyte injury, inflammation and potential fibrosis.

Fibrosis: The pathological accumulation of extracellular matrix in the liver, reflecting disease progression.

Acute myocardial infarction: Necrosis of heart muscle due to prolonged ischaemia, commonly known as a heart attack.

Coronary artery calcification (CAC): Calcium deposition in coronary vessels, quantified by imaging as a marker of atherosclerotic burden.

Follistatin-like protein 3 (FSTL3): A circulating glycoprotein implicated in inflammation and tissue remodelling, recently linked to cardiovascular risk in NAFLD.

References

1. FSTL3 partially mediates the association of increased nonalcoholic fatty liver disease fibrosis risk with acute myocardial infarction in patients with type 2 diabetes mellitus. Cardiovascular Diabetology (2023).
2. Impacts of Non-alcoholic Fatty Liver Disease on Acute Coronary Syndrome: Evidence and Controversies. Current Atherosclerosis Reports (2023).
3. Association of non-alcoholic fatty liver disease with major adverse cardiovascular events: A systematic review and meta-analysis. Scientific Reports (2016).
4. Nonalcoholic fatty liver disease and mortality from all causes, cardiovascular disease, and cancer: a meta-analysis. Scientific Reports (2019).
5. Prognostic value of non-alcoholic fatty liver disease for predicting cardiovascular events in patients with diabetes mellitus with suspected coronary artery disease: a prospective cohort study. Cardiovascular Diabetology (2021).