Irrespective of diabetes, hypertension, or any other known risk factors for cardiovascular disease

The accumulation of fat in the liver, also commonly known as non-alcoholic fatty liver disease, or NAFLD for short, is associated with a 50 percent increased risk of heart failure over the next decade, reveals a pooled data analysis of the available research that was published online in the journal Gut.

Chronic liver disease caused by NAFLD affects up to 30 percent of adults around the world. Because of rising rates of overweight and obesity, the number of people who have it is expected to climb sharply over the next decade.

Recent studies have linked NAFLD to the onset of heart failure, which occurs when the heart is unable to pump enough blood throughout the body. However, it is unclear how big this risk is and whether it varies depending on how severe the liver condition is.

To attempt to answer this question, researchers aggregated the findings of eleven international long-term observational studies published by March 2022. The studies investigated if there might be a connection between heart failure and NAFLD in more than 11 million middle-aged adults.

Four investigations were conducted in Sweden, Finland, and the UK; four in the United States; and three in South Korea.

Half of the people in the study were women, with an average age of 55 and a body mass index (BMI) of 26. A BMI between 18.5 and 24.9 means a healthy weight, 25 to 29.9 means being overweight, and 30 or more means being obese.

One in four (2.9 million; 26 percent) of the study’s participants had NAFLD at the time of the study. Over the course of an average 10-year monitoring period, 97,716 people were diagnosed with heart failure.

The results of all 11 trials were combined, and the analysis of the data revealed that NAFLD was linked to a 50 percent increased risk of heart failure during the observation period. This was true regardless of a person’s age, gender, level of body fat, presence of diabetes or hypertension, race, or any other known risk factors for cardiovascular disease.

To get around the problems that come with different study designs and methods, the researchers combined the data from some studies by study country, length of the monitoring period, method of heart failure diagnosis, and method of NAFLD diagnosis. The results were still the same.

Although this conclusion was based on the results of only 2 trials, the risk appeared to rise in tandem with the severity of NAFLD, particularly with more severe liver fibrosis (scarring), where the risk was 76% greater.

Researchers say they don’t know exactly how NAFLD might raise the risk of heart problems that can lead to heart failure. However, they claim that NAFLD exacerbates systemic insulin resistance, encourages the development of plaque, and produces a cocktail of inflammatory and blood-thinning molecules.

Additionally, they note that more recent diabetic medications that lower blood glucose appear to have some beneficial impacts on the risks of hospitalization for heart failure.

The observational nature of the included studies limits establishing causation, which is one of many limitations the researchers admit for the pooled data analysis.

But given the association between NAFLD and heart failure, they warn that anyone with this condition has to be carefully monitored by a doctor.

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