A common and rising global health concern, fatty liver disease, particularly Non-Alcoholic Fatty Liver Disease (NAFLD), is currently affecting an estimated 30.2% of the world’s population. While prevalence varies by region, in the Americas and Southeast Asia, the rates are above 40%. But that’s not the most concerning part.New research reveals that metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), may ramp up the chances of heart failure, even when traditional risk factors like obesity or diabetes are accounted for.Often symptomless, the condition goes undetected, yet its impact extends far beyond liver health. This isn’t just about the liver anymore; it’s a wake-up call for heart health, and in extension, overall health.
What exactly is Non-Alcoholic Fatty Liver Disease (NAFLD)?
Non-alcoholic fatty liver disease (NAFLD) is a condition where excess fat builds up in the liver, not caused by heavy alcohol consumption. It’s often linked to obesity, type 2 diabetes, and metabolic syndrome. NAFLD encompasses a spectrum of conditions, from simple fat buildup (NAFL) to more serious inflammation and scarring (NASH), fibrosis, cirrhosis, or may even lead to liver cancer.Now, metabolic dysfunction-associated steatotic liver disease (MASLD) is a condition where excess fat builds up in the liver, not caused by excessive alcohol consumption. Essentially, it’s the new term for what was previously known as nonalcoholic fatty liver disease (NAFLD). MASLD is associated with metabolic risk factors like obesity, high blood sugar, high cholesterol, and high blood pressure.
Fatty liver and heart failure: A hidden link
While MASLD is often thought of as a liver condition, health experts warn that heart disease is the leading cause of death in people with fatty liver, even more so than liver complications. The American Heart Association emphasizes that MASLD is a frequently overlooked condition with serious cardiovascular consequences.A new long-term study led by Duke University researchers tracked 570 adults with biopsy-confirmed MASLD over a median of 11 years. The results were eye-opening: 17.9% of these individuals developed heart failure, and nearly 48% showed signs of possible heart trouble, without ever being diagnosed by doctors. The risk was greatest among older adults, women, and those with diabetes.This study is the first to use liver biopsy, the gold standard, for MASLD diagnosis and then directly assess heart failure outcomes. It highlights a major blind spot: many people with fatty liver aren’t being monitored for heart issues, which could mean missed opportunities for early detection and treatment.
How strong is the evidence?
MASLD has already been recognized as an independent risk factor for atherosclerotic cardiovascular disease, artery-clogging conditions that lead to heart attacks and strokes.A major meta-analysis involving over 11 million people across multiple countries found that NAFLD carries a 1.5-fold greater risk of developing heart failure, independent of other factors like age, diabetes, or obesity.Other studies show that MASLD and heart failure share common risk factors like insulin resistance, obesity, and chronic inflammation. MASLD can promote harmful changes in heart structure and function (especially in preventing proper heart muscle relaxation, a type of heart failure called HFpEF).Even more alarming, heart-failure-related death rates among people with NAFLD have doubled in the US over the past two decades, highlighting sharp increases in risk, especially among women and certain ethnic groups in rural or Southern areas.Additionally, cohort studies, including those using the UK Biobank dataset, have shown MASLD is linked to higher overall mortality, cardiovascular deaths, and major cardiac events, even among non-drinkers. Research published in the Journal of the American College of Cardiology confirms that patients with MASLD face greater risks of cardiomyopathy, arrhythmias, and atherosclerosis.
What does this mean, and why does this matter?
Why does fatty liver hurt the heart? As per research, inflammation and insulin resistance triggered by fat-laden liver cells can damage blood vessels and the heart. In addition, endothelial dysfunction, oxidative stress, and systemic inflammation play major roles in causing arterial stiffness and reduced heart function. Apart from that, fatty liver reflects a state of metabolic imbalance, which overlaps with high blood lipid levels, hypertension, and diabetes – all contributors to cardiovascular strain.However, the findings from various research highlight the importance of early detection and management of MASLD, not just to protect the liver, but also to safeguard the heart. How to approach that?Importance of early detection: Recognizing MASLD isn’t just about liver health. It could be the first sign of heart vulnerability. Early detection of both conditions can transform outcomes.Better screening to save lives: Experts recommend that adults with MASLD, especially those with diabetes or high cholesterol, should also be screened for heart issues like diastolic dysfunction or heart failure.Treating both conditions together: Emerging clinical guidance suggests medications such as ACE inhibitors, ARBs, SGLT-2 inhibitors, and others may benefit patients who have both MASLD and heart failure while reducing inflammation and improving outcomes.Fatty liver, often without any connection to alcohol, can quietly increase the risk of serious heart problems like heart failure. With nearly one in five affected over a decade, and strong evidence showing a 1.5times higher risk, this is more than a liver issue; it’s a heart warning.However, with regular screenings and simple yet effective lifestyle changes, we can intercept this dual threat. Consult your healthcare provider in case you, or anyone you know, belongs to a high-risk group; your liver health may be the key to protecting your heart.