Cardiovascular risk across the histological spectrum and the clinical manifestations of non-alcoholic fatty liver disease: An update (original) (raw)
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Non-alcoholic fatty liver disease (NAFLD): a novel cardiovascular risk factor
Internal and Emergency Medicine
Nonalcoholic fatty liver disease (NAFLD) is a common form of primary fatty liver almost universally associated with metabolic risk factors. Histologically, NAFLD is categorized as simple steatosis, which follows a benign course, and its potentially progressive counterpart, nonalcoholic steatohepatitis (NASH). Practicing physicians, while relatively aware of liver-related morbidity and mortality of NAFLD, appear to be more reluctant to engage their NAFLD patients in a protocol of screening and surveillance for cardiovascular disease. This occurs contrary to the alert made by scientific societies about the importance of focusing on vascular complications in addition to liver-related complications. Aiming to get further insight into such a controversial issue, we critically reviewed all the available literature on this hot topic. Clinical studies have been discussed first; next the putative biological mechanisms involved in the NAFLD-atherosclerosis association have been reviewed. Fina...
Non-alcoholic fatty liver and cardiovascular disease: an emerging relationship
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
on-alcoholic fatty liver disease (NAFLD) is a clinicopathological condition characterised by a wide spectrum of histological abnormalities and clinical outcomes. The underlying histological abnormality is hepatic steatosis, characterised by fat accumulation, which may progress to non-alcoholic steatohepatitis (NASH), characterised in turn by steatosis, periportal inflammation, and ballooning degeneration, with or without fibrosis. 1 NASH may progress to cirrhosis and hepatocellular carcinoma. 2-4 Epidemiological and clinical presentation NAFLD is emerging as a major cause of liver-related morbidity and is the most common abnormality observed in hepatological practice. The true prevalence of NAFLD remains to be established. In general population studies its prevalence ranges between 10 and 39% and it is the most common liver disease in adults in the United States. The most common cases are obese, middle-aged women with diabetes. 5,6 Patients with hepatic steatosis alone or steatosis with non-specific inflammation appear to have a mild clinical course. 4 In contrast, 50% of patients with NASH may progress to fibrosis or cirrhosis. 4,7,8 One retrospective study of 30 NASH patients reported a 67% 5-year survival rate and a 59% 10
Current Pharmaceutical Design, 2013
Non-alcoholic fatty liver disease (NAFLD) encompasses pure steatosis through nonalcoholic steatohepatitis (NASH) and is the most common cause of chronic liver disease in Western countries. NASH is a progressive liver disease that increases the risk of cirrhosis and end-stage liver disease. Interestingly, the global health risk of NAFLD is not confined to the liver. Compared with those without NAFLD, patients with NAFLD exhibit not only increased liver-related complications and liver-related mortality but also increased risk of developing type 2 diabetes, cardiovascular disease (CVD) and chronic kidney disease, increased risk of post-operative complications after major liver surgery, and increased risk of developing certain malignancies, including primary liver cancer and colorectal cancer. In this review, we discuss the current evidence linking NAFLD with the risk of CVD in the setting of the more complex scenario of other hepatic and extra-hepatic complications that may occur during the natural course of NAFLD. Moreover, we provide a brief description of the putative biological mechanisms underlying such complications, particular emphasis being given to CVD. We conclude that NAFLD is a complex health problem with implications far beyond the liver. Hence, it may cause a significant global health burden and the assistance of patients with NAFLD impacts on the work of physicians from many different medical specialties.
Non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease: An open question
Nutrition, Metabolism and Cardiovascular Diseases, 2007
Aims: To review available data concerning the basic science and epidemiological-clinical evidence for an association of NAFLD and cardiovascular disease. Data synthesis: Non-alcoholic fatty liver disease (NAFLD) defines alcohol-like hepatic histological lesions seen in the non-alcoholic, insulin resistant patient representing the hepatic counterpart of the metabolic syndrome. Along with insulin resistance, additional genetic, endocrine and vascular changes together with environmental stimulidwhich are also involved in the pathogenesis of atherosclerosisdplay a prominent role in the development and progression of NAFLD. Clinical and epidemiological studies seem to indicate that NAFLD is associated with an increased risk for cardiovascular disease but further studies are needed to confirm the available data. The mainstay of NAFLD treatment is based on the correction of the same metabolic changes that predispose to atherosclerosis. Conclusions: Non-invasive evaluation of risk for cardiovascular events is recommended in all individuals presenting with NAFLD and conversely, the presence Abbreviations: MS, metabolic syndrome; T2DM, type 2 diabetes mellitus; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; IR, insulin resistance; GH, growth hormone; CRP, C-reactive protein; PPAR-gamma, peroxisome proliferator-activated receptor gamma; UCP-2, uncoupling protein-2. www.elsevier.com/locate/nmcd of NAFLD should always be looked for in subjects with features belonging to the metabolic syndrome. Further studies are needed on the mechanisms linking fatty liver and vascular diseases. ª
Atherosclerosis, 2013
Background: Non-alcoholic fatty liver disease (NAFLD) is an emerging disease and a leading cause of chronic liver disease. The prevalence in the general population is approximately 15e30% and it increases to 70e90% in obese or diabetic populations. NAFLD has been linked to increased cardiovascular disease (CVD) risk. It is therefore critical to evaluate the relationship between markers of subclinical CVD and NAFLD. Method: An extensive search of databases; including the National Library of Medicine and other relevant databases for research articles meeting inclusion criteria: observational or cohort, studies in adult populations and clearly defined NAFLD and markers of subclinical CVD. Results: Twenty-seven studies were included in the review; 16 (59%) presented the association of NAFLD and carotid intima-media thickness (CIMT), 7 (26%) the association with coronary calcification and 7 (26%) the effect on endothelial dysfunction and 6 (22%) influence on arterial stiffness. CIMT studies showed significant increases among NAFLD patients compared to controls. These were independent of traditional risk factors and metabolic syndrome. The association was similar in coronary calcification studies. The presence of NAFLD is associated with the severity of the calcification. Endothelial dysfunction and arterial stiffness showed significant independent associations with NAFLD. Two studies argued the associations were not significant; however, these studies were limited to diabetic populations. Conclusion: There is evidence to support the association of NAFLD with subclinical atherosclerosis independent of traditional risk factors and metabolic syndrome. However, there is need for future longitudinal studies to review this association to ascertain causality and include other ethnic populations.
Non-alcoholic fatty liver disease and increased risk of cardiovascular disease
Atherosclerosis, 2007
Non-alcoholic fatty liver disease (NAFLD) is present in up to one-third of the general population and in the majority of patients with cardio-metabolic risk factors such as abdominal obesity, type 2 diabetes and other components of the metabolic syndrome (MetS). Currently, the importance of NAFLD and its relationship to the MetS is increasingly recognized, and this has stimulated an interest in the possible role of NAFLD in the development of cardiovascular disease (CVD). Indeed, the impact of NAFLD on CVD risk deserves particular attention in view of the implications for screening/surveillance strategies in this growing number of patients. Recent evidence suggests that the severity of liver histology in NAFLD patients is closely associated with markers of early atherosclerosis such as greater carotid artery wall thickness and lower endothelial flow-mediated vasodilation independently of classical risk factors and components of the MetS. Moreover, NAFLD is associated with greater overall mortality and independently predicts the risk of future CVD events. Overall, the current body of evidence strongly suggests that NAFLD is likely to be associated with increased CVD risk, and raises the possibility that NAFLD may be not only a marker but also an early mediator of atherosclerosis.
The Role of Non-Alcoholic Fatty Liver Disease in Cardiovascular Disease
Digestive Diseases, 2010
Background/Aims: Fatty liver is the hepatic component of the metabolic syndrome. Insulin resistance, the pathogenic driver of the metabolic syndrome, refers to a constellation of features such as overweight/obesity, glucose intolerance, dyslipidemia and hypertension, all of which are important risk factors for cardiovascular disease (CVD). The aim of this article is to summarize the available data linking non-alcoholic fatty liver disease (NAFLD) with CVD. Methods: Two approaches were used to address this issue. First, data in support of the presence of the typical in vivo pathogenic features of atherosclerosis in individuals with NAFLD were described to confirm whether or not the association between NAFLD and CVD is plausible. Second, epidemiological data linking NAFLD with CVD outcome was reviewed. Results: Individuals with NAFLD are characterized by abnormal endothelial function. Data about the carotid intima-media thickness, which as a surrogate marker of atherosclerosis, are co...
Nonalcoholic Fatty Liver Disease and the Coronary Artery Disease
Digestive Diseases and Sciences, 2010
Background Nonalcoholic fatty liver disease (NAFLD) is increasingly prevalent and is recognized as part of the metabolic syndrome (MetS). Patients with NAFLD have a lower life expectancy compared to the general population, with coronary artery disease (CAD) as the leading cause of death. Aims We aim to address the epidemiological data of CAD, the possible pathogenesis or linkage mechanisms of NAFLD and atherosclerosis and the strategies to reduce the CAD risk in NAFLD patients. Methods We reviewed data from a Medline and PubMed search which was performed to identify relevant literature using search terms ''NAFLD,'' ''metabolic syndrome'' and ''coronary artery disease.'' Results Patients with steatohepatitis, a part of the spectrum of NAFLD, have more cardiovascular events than patients without steatohepatitis. However, the association between liver histological progression and the risk of CAD events is not linear. A multidisciplinary approach to NAFLD patients based on controlling related risk factors and monitoring for CAD risks and liver complications is necessary. The combination of lifestyle modification with pharmacological treatment tailored to each individual's risk factors needs to be considered. There is a need for more research on primary prevention for CAD in NAFLD patients and interventional studies for determining the nature of the relationship between NAFLD and CAD. Conclusions NAFLD is recognized as part of the MetS and increases cardiovascular risks. Therefore, a multidisciplinary approach to these patients of controlling the related risk factors and monitoring for cardiovascular and liver complications must be done.