Non-Alcoholic Fatty Liver Disease Increases Risk of Heart Failure


Records from 11 million patients shows 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 Gut. NAFLD affects approximately 30% of adults globally, 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 amount of people afflicted by NAFLD will also increase.2

Giovanni Targher, MD, of the University of Verona in Italy, told MedPage Today that, “Health care professionals should be aware that risk of new-onset heart failure is moderately higher in patients with NAFLD.”3

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

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

The average age of participants, half of whom were women, was 55 years. 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 25-29.9 indicates overweight and a BMI of 30 is considered obese.1

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

All 11 studies had different study designs, so researchers decided to pool the data by county, length of monitoring period, and method of NAFLD and heart failure diagnosis. The results were the same either way.1

NAFLD can lead to insulin resistance that creates plaque, inflammation, and thickens blood that can develop into heart failure.1 A potential treatment for heart failure is newer diabetes drugs; these lower blood glucose and appear to decrease the risk of hospitalization for heart failure. Otherwise, other treatments are still being researched.1

Although the cause of this disease is not entirely known, NAFLD seems to be associated with metabolic syndrome, arising from complications from a high BMI; these could include high blood lipid levels, high blood pressure, and diabetes.2 Other possible causes could include a diet high in fructose that leads to metabolic syndrome, and genetics.2

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

“Because of the link between the 2 conditions, more careful surveillance of these patients will be needed," Targher concluded.3


  1. Fat build-up in liver (NAFLD) linked to heightened heart failure risk over next decade. EurkeAlert!. July 25, 2022. Accessed July 26, 2022.
  2. Non-Alchoholic Fatty Liver Disease. Last review by a Cleveland Clinic medical professional on February 5, 2022. Accessed July 26, 2022.
  3. Hamza, Zaina. NAFLD Tied to Higher Risk of Heart Failure. MedPage Today. July 25, 2022. Accessed July 26, 2022.
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