Highlights
- •NAFLD is highly prevalent ranging from steatosis to cirrhosis.
- •NAFLD advanced forms associated with cardiovascular risk.
- •NAFLD studies limited by heterogeneity and confounders.
- •Genetic variants predisposing to NAFLD not consistently associated with cardiovascular events.
- •No proof that NAFLD is causal of cardiovascular disease.
Abstract
Non-alcoholic fatty liver disease (NAFLD) is highly prevalent and includes a spectrum
of abnormalities ranging from steatosis to cirrhosis. In this review, we address recent
evidence and limitations of studies that evaluated the association of NAFLD with atherosclerotic
cardiovascular disease. NAFLD is considered an ectopic fat deposit associated with
metabolic (insulin resistance, hyperglycemia and dyslipidemia), inflammatory, coagulation
and blood pressure disturbances. Prospective studies have associated NAFLD presence
and severity, particularly steatohepatitis and fibrosis, with an increased risk of
cardiovascular disease. However, these studies are limited by heterogeneity concerning
NAFLD diagnostic criteria and disease severity stratification, as well as by the presence
of confounding factors. In addition, genetic variants predisposing to NAFLD, such
as the PNPLA3 I148M mutation, were not consistently associated with an increased risk of cardiovascular
events. Therefore, currently, it is not possible to prove a causal relation between
NAFLD and cardiovascular disease. Furthermore, there is presently no evidence that
NAFLD diagnosis can be used as a tool to improve cardiovascular risk stratification
and modify treatment. Specific treatments for NAFLD are being developed and must be
tested prospectively in adequately designed trials to determine the potential of reducing
both hepatic and cardiovascular diseases and to prove whether NAFLD is indeed a cause
of atherosclerosis.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: January 30, 2019
Accepted:
January 18,
2019
Received in revised form:
December 22,
2018
Received:
July 27,
2018
Identification
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© 2019 Elsevier B.V. All rights reserved.
