Does nonalcoholic fatty liver disease cause cardiovascular disease? Current knowledge and gaps

Raul D. Santos, Luca Valenti, Stefano Romeo

Research output: Contribution to journalReview articlepeer-review


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.

Original languageEnglish
Pages (from-to)110-120
Number of pages11
Publication statusPublished - Mar 1 2019


  • Atherosclerosis
  • Diabetes
  • Genetics
  • Hepatic steatosis
  • Non-alcoholic fatty liver disease
  • Obesity
  • Risk stratification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Does nonalcoholic fatty liver disease cause cardiovascular disease? Current knowledge and gaps'. Together they form a unique fingerprint.

Cite this