Ciornolutchii Vera, Ismaiel Abdulrahman, Bogdan Jennifer, Popa Stefan-Lucian, Surdea-Blaga Teodora, Dumitrascu Dan L
2nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Faculty of Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Eur J Clin Invest. 2025 Oct;55(10):e70075. doi: 10.1111/eci.70075. Epub 2025 May 19.
Fatty liver disease, encompassing nonalcoholic fatty liver disease (NAFLD), metabolic dysfunction-associated fatty liver disease (MAFLD), and the recently redefined metabolic dysfunction-associated steatotic liver disease (MASLD), is a growing global health concern with significant cardiovascular implications. Peripheral artery disease (PAD), a common manifestation of systemic atherosclerosis, shares key pathophysiological mechanisms with fatty liver disease, including insulin resistance, systemic inflammation and endothelial dysfunction. Although emerging evidence suggests a link between fatty liver disease and PAD, the nature and extent of this association remain unclear. This systematic review synthesizes current research evaluating the relationship between fatty liver disease and PAD.
A systematic search of PubMed, Embase and Scopus was conducted up to December 19, 2024, following PRISMA 2020 guidelines. Eligible observational studies assessing PAD in MASLD, MAFLD or NAFLD patients were included. Quality assessment was performed independently by two reviewers using the Newcastle-Ottawa Scale (NOS).
Eleven observational studies, including approximately 848,027 participants, were analysed. Most studies reported a significant association between NAFLD or MAFLD and increased PAD risk, particularly in individuals with type 2 diabetes and metabolic syndrome. Studies using MAFLD criteria demonstrated a stronger association with PAD than those using NAFLD definitions. The presence of hepatic fibrosis was linked to a higher PAD risk in some studies. However, not all studies found a consistent relationship, and a few reported no independent association between fatty liver disease and PAD, highlighting the need for further research. Notably, none of the included studies used MASLD criteria.
Patients with NAFLD or MAFLD, particularly those with metabolic comorbidities, may have an elevated risk of PAD. The severity of liver disease, including fibrosis, appears to contribute to this risk. Future studies should incorporate MASLD definitions and advanced diagnostic methods to clarify this relationship and guide clinical strategies for integrated cardiovascular and liver disease management.
脂肪性肝病，包括非酒精性脂肪性肝病（NAFLD）、代谢功能障碍相关脂肪性肝病（MAFLD）以及最近重新定义的代谢功能障碍相关脂肪性肝病（MASLD），是一个日益受到全球关注的健康问题，对心血管系统有重大影响。外周动脉疾病（PAD）是全身动脉粥样硬化的常见表现，与脂肪性肝病具有共同的关键病理生理机制，包括胰岛素抵抗、全身炎症和内皮功能障碍。尽管新出现的证据表明脂肪性肝病与PAD之间存在联系，但这种关联的性质和程度仍不清楚。本系统评价综合了当前评估脂肪性肝病与PAD之间关系的研究。
按照PRISMA 2020指南，截至2024年12月19日，对PubMed、Embase和Scopus进行了系统检索。纳入评估MASLD、MAFLD或NAFLD患者PAD的合格观察性研究。由两名审阅者使用纽卡斯尔-渥太华量表（NOS）独立进行质量评估。
分析了11项观察性研究，包括约848,027名参与者。大多数研究报告NAFLD或MAFLD与PAD风险增加之间存在显著关联，特别是在2型糖尿病和代谢综合征患者中。使用MAFLD标准的研究显示与PAD的关联比使用NAFLD定义的研究更强。在一些研究中，肝纤维化的存在与更高的PAD风险相关。然而，并非所有研究都发现了一致的关系，少数研究报告脂肪性肝病与PAD之间无独立关联，这突出了进一步研究的必要性。值得注意的是，纳入的研究均未使用MASLD标准。
NAFLD或MAFLD患者，尤其是那些有代谢合并症的患者，可能有更高的PAD风险。肝病的严重程度，包括纤维化，似乎促成了这种风险。未来的研究应纳入MASLD定义和先进的诊断方法，以阐明这种关系，并指导心血管和肝病综合管理的临床策略。
