NAFLD, cardiovascular and cardiac diseases: factors influencing risk, prediction, and treatment: Factors influencing risk, prediction and treatment
NAFLD, cardiovascular and cardiac diseases: factors influencing risk, prediction, and treatment: Factors influencing risk, prediction and treatment
Background and aim: Non-alcoholic fatty liver disease (NAFLD), affecting up to around 30% of the world's adult population, causes considerable liver-related and extrahepatic morbidity and mortality. Strong evidence indicates that NAFLD (especially its more severe forms) is associated with a greater risk of all-cause mortality, and the predominant cause of mortality in this patient population is cardiovascular disease (CVD). This narrative review aims to discuss the strong association between NAFLD and increased risk of cardiovascular, cardiac and arrhythmic complications. Also discussed are the putative mechanisms linking NAFLD to CVD and other cardiac/arrhythmic complications, with a brief summary of CVD risk prediction/stratification and management of the increased CVD risk observed in patients with NAFLD. Results: NAFLD is associated with an increased risk of CVD events and other cardiac complications (left ventricular hypertrophy, valvular calcification, certain arrhythmias) independently of traditional CVD risk factors. The magnitude of risk of CVD and other cardiac/arrhythmic complications parallels the severity of NAFLD (especially liver fibrosis severity). There are most likely multiple underlying mechanisms through which NAFLD may increase risk of CVD and cardiac/arrhythmic complications. Indeed, NAFLD exacerbates hepatic and systemic insulin resistance, promotes atherogenic dyslipidaemia, induces hypertension, and triggers synthesis of proatherogenic, procoagulant and proinflammatory mediators that may contribute to the development of CVD and other cardiac/arrhythmic complications. Conclusion: Careful assessment of CVD risk is mandatory in patients with NAFLD for primary prevention of CVD, together with pharmacological treatment for coexisting CVD risk factors.
Arrhythmias, CVD, Heart disease, NAFLD, Non-alcoholic fatty liver disease
Targher, Giovanni
043e0811-b389-4922-974e-22e650212c5f
Corey, Kathleen E.
02055164-4013-492b-833b-b55665b88f40
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
6 March 2021
Targher, Giovanni
043e0811-b389-4922-974e-22e650212c5f
Corey, Kathleen E.
02055164-4013-492b-833b-b55665b88f40
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Targher, Giovanni, Corey, Kathleen E. and Byrne, Christopher
(2021)
NAFLD, cardiovascular and cardiac diseases: factors influencing risk, prediction, and treatment: Factors influencing risk, prediction and treatment.
Diabetes & Metabolism, 47 (2), [101215].
(doi:10.1016/j.diabet.2020.101215).
Abstract
Background and aim: Non-alcoholic fatty liver disease (NAFLD), affecting up to around 30% of the world's adult population, causes considerable liver-related and extrahepatic morbidity and mortality. Strong evidence indicates that NAFLD (especially its more severe forms) is associated with a greater risk of all-cause mortality, and the predominant cause of mortality in this patient population is cardiovascular disease (CVD). This narrative review aims to discuss the strong association between NAFLD and increased risk of cardiovascular, cardiac and arrhythmic complications. Also discussed are the putative mechanisms linking NAFLD to CVD and other cardiac/arrhythmic complications, with a brief summary of CVD risk prediction/stratification and management of the increased CVD risk observed in patients with NAFLD. Results: NAFLD is associated with an increased risk of CVD events and other cardiac complications (left ventricular hypertrophy, valvular calcification, certain arrhythmias) independently of traditional CVD risk factors. The magnitude of risk of CVD and other cardiac/arrhythmic complications parallels the severity of NAFLD (especially liver fibrosis severity). There are most likely multiple underlying mechanisms through which NAFLD may increase risk of CVD and cardiac/arrhythmic complications. Indeed, NAFLD exacerbates hepatic and systemic insulin resistance, promotes atherogenic dyslipidaemia, induces hypertension, and triggers synthesis of proatherogenic, procoagulant and proinflammatory mediators that may contribute to the development of CVD and other cardiac/arrhythmic complications. Conclusion: Careful assessment of CVD risk is mandatory in patients with NAFLD for primary prevention of CVD, together with pharmacological treatment for coexisting CVD risk factors.
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Accepted/In Press date: 11 November 2020
e-pub ahead of print date: 6 December 2020
Published date: 6 March 2021
Additional Information:
Funding Information:
G.T. is supported in part by grants from the School of Medicine, University of Verona, Verona, Italy . C.D.B. is supported in part by the Southampton NIHR Biomedical Research Centre (IS-BRC-20004) in Southampton, UK.
Publisher Copyright:
© 2020 Elsevier Masson SAS
Keywords:
Arrhythmias, CVD, Heart disease, NAFLD, Non-alcoholic fatty liver disease
Identifiers
Local EPrints ID: 445150
URI: http://eprints.soton.ac.uk/id/eprint/445150
ISSN: 1262-3636
PURE UUID: ecd644f8-9e41-45ce-950e-20feae17266e
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Date deposited: 23 Nov 2020 17:31
Last modified: 17 Mar 2024 06:05
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Author:
Giovanni Targher
Author:
Kathleen E. Corey
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