General Medicine and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy.
Eur J Clin Invest. 2021 Jul;51(7):e13519. doi: 10.1111/eci.13519. Epub 2021 Mar 2.
A consensus of experts has proposed to replace the term nonalcoholic fatty liver disease (NAFLD), whose global prevalence is 25%, with metabolic dysfunction-associated fatty liver disease (MAFLD), to describe more appropriately the liver disease related to metabolic derangements. MAFLD is closely intertwined with type 2 diabetes, obesity, dyslipidaemia, all linked to a rise in the risk of cardiovascular disease (CVDs). Since controversy still stands on whether or not NAFLD/MAFLD raises the odds of CVD, the present review aims to evaluate the impact of NAFLD/MAFLD aetiologies on CV health and the potential correction by dietary and drug approaches.
Epidemiological studies indicate that NAFLD raises risk of fatal or non-fatal CVD events. NAFLD patients have a higher prevalence of arterial plaques and stiffness, coronary calcification, and endothelial dysfunction. Although genetic and environmental factors strongly contribute to NAFLD pathogenesis, a Mendelian randomization analysis indicated that the PNPLA3 genetic variant leading to NAFLD may not be causally associated with CVD risk. Among other genetic variants related to NAFLD, TM6SF2 appears to be protective, whereas MBOAT7 may favour venous thromboembolism.
NAFLD is correlated to a higher CVD risk which may be ameliorated by dietary interventions. This is not surprising, since new criteria defining MAFLD include other metabolic risk abnormalities fuelling development of serious adverse extrahepatic outcomes, for example CVD. The present lack of a targeted pharmacological approach makes the identification of patients with liver disease at higher CVD risk (eg diabetes, hypertension, obesity or high levels of C-reactive protein) of major clinical interest.
专家共识建议用代谢相关脂肪性肝病（MAFLD）取代全球患病率为 25%的非酒精性脂肪性肝病（NAFLD）这一术语，以更恰当地描述与代谢紊乱相关的肝病。MAFLD 与 2 型糖尿病、肥胖症、血脂异常密切相关，所有这些都与心血管疾病（CVD）风险的增加有关。由于关于 NAFLD/MAFLD 是否会增加 CVD 的风险仍存在争议，本综述旨在评估 NAFLD/MAFLD 病因对 CV 健康的影响，以及饮食和药物方法纠正的可能性。
流行病学研究表明，NAFLD 会增加致命或非致命 CVD 事件的风险。NAFLD 患者动脉斑块和僵硬、冠状动脉钙化和内皮功能障碍的发生率更高。尽管遗传和环境因素对 NAFLD 的发病机制有很大影响，但孟德尔随机分析表明，导致 NAFLD 的 PNPLA3 遗传变异可能与 CVD 风险没有因果关系。在与 NAFLD 相关的其他遗传变异中，TM6SF2 似乎具有保护作用，而 MBOAT7 可能有利于静脉血栓栓塞。
NAFLD 与更高的 CVD 风险相关，饮食干预可能会改善这种情况。这并不奇怪，因为定义 MAFLD 的新标准包括其他代谢风险异常，这些异常会助长严重的肝外不良后果的发展，例如 CVD。目前缺乏针对肝脏疾病的靶向药物治疗方法，使得识别具有更高 CVD 风险的患者（如糖尿病、高血压、肥胖或 C 反应蛋白水平升高）成为主要的临床关注点。
