Association Between Fatty Liver and Cardiovascular Disease: Mechanism and Clinical Implications

NAFLD is associated with major cardiovascular risk factors including type 2 diabetes mellitus (T2DM), obesity, dyslipidemia, hypertension and insulin resistance and constitutes a new component of the metabolic syndrome (MetS) [1-2].The association of MetS and NAFLD is so strong that NAFLD is considered as the hepatic manifestation of MetS [3]. The clinical implication of NAFLD and nonalcoholic steatohepatitis (NASH) are mainly derived from their common occurrence in the general population (15%-30%) and their potential to contribute to CAD, extra hepatic cancer, diabetes, and progression to fibrosis (30%-40%), cirrhosis (20%-30%) and hepatocellular carcinoma [4-5]. Although the mechanisms underlying liver disease progression remain unclear, insulin resistance and obesity-related inflammation, obesity related ectopic fat and lipotoxicity play a key role, along with possible genetic, dietary and life style factors [6]. Most studies show that MetS is associated with a two-fold increase in CAD risk and a 5-fold increased risk for incidences of T2DM [7-12]. The importance of NAFLD component within the MetS is now increasingly recognized, and this has stimulated an interest in the possible relationship between NAFLD and cardiovascular disease (CVD). This review focuses on the relationship between NAFLD and CAD, the Biological mechanisms linking NAFLD and CAD and a proposed new treatment approach for patients with NAFLD.