Non-alcoholic fatty liver disease increases the risk of heart failure

Records of 11 million patients show that non-alcoholic fatty liver disease could increase the risk of developing heart failure by 50%.

Non-alcoholic fatty liver disease (NAFLD) may increase the risk of heart failure, according to a new meta-analysis published in the journal Intestine. NAFLD affects approximately 30% of adults worldwide and is considered the most common cause of chronic liver disease.1

Up to 75% of people with NAFLD are overweight or diabetic. As levels of overweight and obesity increase, it is predicted that the number of people with NAFLD will also increase.2

Giovanni Targher, MD, of the University of Verona in Italy, said MedPage today that “health care professionals should be aware that the risk of new onset heart failure is moderately increased in patients with NAFLD”.3

NAFLD symptoms only appear if the disease progresses to non-alcoholic steatohepatitis (NASH), which causes chronic inflammation of the liver and can worsen liver disease over time.2

For this meta-analysis, researchers gathered results from more than 11 million middle-aged adults who participated in 1 of 11 long-term international observational studies, 4 of which were from Europe (Sweden, Finland and United Kingdom), 4 from the United States and 3 from South Korea. All studies have looked at possible links between NAFLD and heart failure.1

The average age of the participants, half of whom were women, was 55. They had an average body mass index (BMI) of 26, which is slightly above the healthy range of 18.5 and 24.9. A BMI of 25 to 29.9 indicates overweight and a BMI of 30 is considered obese.1

Approximately 2.9 million (26%) of participants had NSFLD.1 Researchers found that NAFLD increased their risk of developing heart failure by 50% during the monitoring period,1 which increased directly with the severity of NAFLD.3 A total of 97,716 participants were diagnosed with heart failure, regardless of age, gender, body fat, diabetes, high blood pressure, ethnicity and other risk factors common cardiovascular events.1

The 11 studies had different study designs, so the researchers decided to pool the data by county, length of monitoring period, and method of diagnosing NAFLD and heart failure. The results were the same in both directions.1

NAFLD can lead to insulin resistance which creates plaque, inflammation and thickens the blood which can progress to heart failure.1 A potential treatment for heart failure is new diabetes drugs; these lower blood sugar and appear to decrease the risk of hospitalization for heart failure. Otherwise, other treatments are still being studied.1

Although the cause of this condition is not fully known, NAFLD appears to be associated with the metabolic syndrome, resulting from the complications of high BMI; these could include high blood lipid levels, high blood pressure and diabetes.2 Other possible causes could include a high fructose diet which leads to metabolic syndrome and genetics.2

The observational nature of the study severely limits the data.1 Other limitations include potential unmeasured and residual confounding and lack of changes in glucose tolerance status, according to the study authors.3

“Because of the link between the 2 conditions, more careful monitoring of these patients will be required,” Targher concluded.3


  1. Accumulation of fat in the liver (NAFLD) linked to increased risk of heart failure over the next decade. Eurke alert!. July 25, 2022. Accessed July 26, 2022.
  2. Non-alcoholic fatty liver disease. Last reviewed by a Cleveland Clinic healthcare professional on February 5, 2022. Accessed July 26, 2022.
  3. Hamza, Zaina. NAFLD linked to higher risk of heart failure. MedPage Today. July 25, 2022. Accessed July 26, 2022.

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