This association has only recently started to gain recognition among cardiologists, with the American Heart Association affirming that individuals with NAFLD possess increased cardiovascular risks compared with those without. Although the molecular underpinnings of this association have yet to be fully understood, several hypotheses pinpoint metabolic syndrome, a major contributor to both CVDs and NAFLD, as an upstream metabolic defect with end-organ manifestations in both the heart and the liver.
This review aims to summarise and interpret existing evidence about the association between NAFLD and CVDs.
NAFLD is associated with coronary artery disease, aortic valve sclerosis, mitral annulus calcifications, atrial fibrillation, prolonged QTc intervals, heart block, premature atrial/ventricular contract, and stroke. Importantly, NAFLD is associated with increased risks of heart failure with preserved ejection fraction (HFpEF), with NAFLD patients experiencing a higher HFpEF prevalence than those without. NAFLD-related HFpEF phenotypes include obstructive HFpEF, metabolic HFpEF, and advanced liver fibrosis HFpEF. Moreover, NAFLD is linked with increased risks of heart failure with reduced ejection fraction (HFrEF). In light of these findings, a comprehensive and multidisciplinary approach to the diagnosis and management of patients with NAFLD and cardiac disease is urgently needed. Clear guidance on screening for CVD in NAFLD patients, as well as for NAFLD in individuals with CVD, is also needed to optimise patient outcomes.