Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Diabetes Metab. 2021 Mar;47(2):101215. doi: 10.1016/j.diabet.2020.101215. Epub 2020 Dec 6.
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.
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.
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.
非酒精性脂肪性肝病（NAFLD）影响着全球约 30%的成年人，导致了相当数量的与肝脏相关和肝外的发病率和死亡率。强有力的证据表明，NAFLD（尤其是其更严重的形式）与全因死亡率风险增加相关，而该患者群体的主要死亡原因是心血管疾病（CVD）。本叙述性综述旨在讨论 NAFLD 与心血管、心脏和心律失常并发症风险增加之间的密切关联。同时还讨论了将 NAFLD 与 CVD 及其他心脏/心律失常并发症联系起来的潜在机制，并简要总结了 CVD 风险预测/分层以及 NAFLD 患者观察到的 CVD 风险增加的管理。
NAFLD 与 CVD 事件和其他心脏并发症（左心室肥厚、瓣膜钙化、某些心律失常）的风险增加独立于传统 CVD 危险因素相关。CVD 和其他心脏/心律失常并发症的风险程度与 NAFLD 的严重程度（尤其是肝纤维化严重程度）相平行。NAFLD 可能通过多种潜在机制增加 CVD 和心脏/心律失常并发症的风险。事实上，NAFLD 加重了肝脏和全身胰岛素抵抗，促进了致动脉粥样硬化的血脂异常，导致了高血压，并引发了促动脉粥样硬化、促凝和促炎介质的合成，这些可能导致 CVD 和其他心脏/心律失常并发症的发展。
对于 NAFLD 患者，必须进行仔细的 CVD 风险评估，以进行 CVD 的一级预防，并对并存的 CVD 危险因素进行药物治疗。
