Risk of Cardiovascular Disease in Patients with Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease encompasses a spectrum of pathologic conditions, ranging from simple steatosis to nonalcoholic steatohepatitis and cirrhosis. The disease has reached epidemic proportions and is the most common cause of chronic liver disease in Western countries.(1-4) Approximately 20 to 30% of adults in the general population in Western countries have nonalcoholic fatty liver disease, and its prevalence increases to 70 to 90% among persons who are obese or have diabetes; such patients are also at increased risk for the development of advanced fibrosis and cirrhosis.(1-4) Recognition of the importance of nonalcoholic fatty liver disease and its strong association with the metabolic syndrome(1-4) has stimulated interest in its putative role in the development and progression of cardiovascular disease.(5) Accumulating evidence suggests that cardiovascular disease dictates the outcome (or outcomes) in patients with nonalcoholic fatty liver disease more frequently and to a greater extent than does the progression of liver disease.(2,4,5) This review focuses on the rapidly expanding body of clinical evidence that supports a strong association between nonalcoholic fatty liver disease and the risk of cardiovascular disease. Because of the link between the two disorders, more careful surveillance of these patients will be needed.