NAFLD links to increased risk for cardiovascular events

Nonalcoholic fatty liver disease correlated with an increased long-term risk for cardiovascular events and may be an independent risk factor for CVD morbidity and mortality, according to research.

“The clinical burden of NAFLD is not only restricted to its liver-related complications, but also includes an increased risk for CVD,” Alessandro Mantovani, MD, University and Azienda Ospedaliera Universitaria Integrata of Verona, Italy, and colleagues wrote. “To our knowledge, there are only three previous meta-analyses that have examined the association between NAFLD and risk of CVD mortality and morbidity. These meta-analyses showed that NAFLD is associated with an increased risk for incident CVD while the available data on its association with CVD mortality were conflicting.”

To quantify the association between NAFLD and the risk for CVD events, researchers systematically reviewed 36 longitudinal studies comprising 5,802,226 individuals (mean age, 53 years) with and without NAFLD. Over a median follow-up of 6.5 years, they noted 99,668 incident cases of fatal and non-fatal CVD events. Pooled random effects models determined NAFLD was associated with an increased risk for fatal CVD events (HR = 1.3; 95% CI, 1.08-1.56) and an increased risk for non-fatal CVD events (HR = 1.2; 95% CI, 1.2-1.64), which increased across disease severity (HR = 2.29; 95% CI, 1.74-3.03). Researchers noted similar results when they analyzed only studies exploring the association between liver fibrosis severity and risk for CVD events (HR = 2.5; 95% CI, 1.68-3.72).

“This comprehensive and updated meta-analysis provides evidence for a significant association between the presence of NAFLD and the long-term risk of fatal and non-fatal CVD events. ... Clinicians should have a high index of suspicion that individuals with NAFLD may also have co-existing CVD,” Mantovani and colleagues concluded. “The complex interplay between the liver and cardiometabolic risk factors in NAFLD highlights an urgent need for a person-centered, multidisciplinary and holistic approach to manage both liver disease and cardiometabolic risk.”