NAFLD and Cardiovascular Diseases: Epidemiological, Mechanistic and Therapeutic Considerations

Abstract

Overwhelming evidence suggests an association of cardiovascular disease (CVD) with non-alcoholic fatty liver disease (NAFLD); however, the underlying mechanisms remain largely speculative. It is, however, likely that common mechanisms contribute to the development of CVD and NAFLD, with lifestyle factors such as smoking, sedentary lifestyle with poor nutrition habits and physical inactivity being major candidates. These behavioral factors, on a predisposing genetic background, trigger changes in gut microbiota, inflammation, dyslipidemia and oxidative stress, leading to metabolic syndrome, diabetes and obesity as well as atherosclerosis. Treatment options to counteract both the progression and development of CVD and NAFLD include lifestyle interventions, optimal medical therapy of comorbid conditions and, as final possibility, bariatric surgery. As no causal pharmacotherapy of NAFLD is available, further research is urgently needed to address the unmet need of a growing population with NAFLD and CVD.

Keywords: NASH; atherosclerosis; diabetes; exercise; lifestyle; liver; metabolic syndrome; nutrition.

Figure 1

Substantial epidemiological data that link non-alcoholic fatty liver disease (NAFLD) to cardiovascular disease (CVD).

Figure 2

Several possible mechanisms have been proposed that might explain the association between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD). All of these possible mechanisms are associated with lifestyle factors.

Figure 3

Besides lifestyle intervention and, for some patients, surgery, a number of established and emerging CV medications might play a role in the treatment of NAFLD complicated by CVD.