Nonalcoholic fatty liver disease (NAFLD) is characterised by the presence of hepatic
steatosis without significant alcohol consumption or concomitant liver disease. Cardiovascular disease (CVD) is a leading cause of death in people living with NAFLD. Patients with comorbidities associated with NAFLD (type 2 diabetes, obesity, metabolic syndrome, and dyslipidemia) are at higher risk of increased cardiovascular morbidity and mortality.
This review aimed to provide a comprehensive summary of the existing evidence supporting an association between NAFLD and CVDs.
NAFLD is associated with coronary artery disease, aortic valve sclerosis, and/or mitral annulus calcifications. A link was also established between NAFLD and atrial fibrillation, prolonged QT intervals, heart block, premature atrial/ventricular contract, and stroke.
Importantly, NAFLD was found to be associated with increased prevalence of heart failure with preserved ejection fraction (HFpEF). NAFLD-related HFpEF phenotypes included HFpEF, metabolic HFpEF, and advanced liver fibrosis HFpEF.
The prevalence of NAFLD in HFpEF patients was also higher than in the general population, and patients with NAFLD also had an increased risk of developing heart failure with reduced ejection fraction (HFrEF).
The mechanisms of the association between NAFLD and CVDs remain unclear, although it has been proposed that metabolic syndrome might act as an upstream metabolic defect, leading to extrahepatic complications manifesting in the heart.