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Non-alcoholic fatty liver disease (NAFLD) and cardiovascular risk

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Published Date

October 18, 2021

Liver, the largest solid organ, is a powerhouse that performs many vital bodily functions but is often undervalued.  Some of the liver’s most critical functions include:

Storing energy from carbohydrates (in the form of glycogen), like a battery, to meet the body’s demands when needed
Secreting bile to digest fat and absorb vitamins
Disposing chemicals like alcohol and medications as well as regulating cholesterol – an essential ingredient of cell membranes – within the body.

Despite the important role that the liver has on overall health, many do not monitor or even consider their liver health. Did you know that 1 in 4 adults in Western countries suffer from a chronic liver disease called Non-Alcoholic Fatty Liver Disease (NAFLD), which is often associated with obesity and type 2 diabetes mellitus?

What is NAFLD?

Unless a patient has hereditary disorders, viral infections, takes certain medications such as corticosteroids, or consumes a significant amount of alcohol (< 30g/day for men, and 20 g/day for women), the liver maintains a healthy balance between fat acquisition and disposal. In fact, healthy liver cells typically have less than 5% fat. However, when this balance is disrupted due to metabolic disorders, excess fat accumulates in the liver cells resulting in a condition called non-alcoholic fatty liver (NAFL). Research shows that roughly a fifth of those with fatty liver disease progress to develop liver inflammation, or non-alcoholic steatohepatitis (NASH). NAFLD is an umbrella term used to refer to those with NAFL and NASH. Inflammation of the liver due to NAFLD can result in a buildup of scar tissue in the liver (fibrosis). Extensive scar build up is called cirrhosis and can cause significant problems.

NAFLD and heart disease

Complications due to NAFLD extend beyond the liver.  Studies show that patients with NAFLD are more likely to die from complications from cardiovascular disease (CVD) than from liver disease1.  While those with severe NAFLD may be at higher risk of complications due to liver failure, recent evidence suggests that those with mild or moderate levels of NAFLD have a 64% higher risk of developing serious complications including death due to CVD2.  The risk of complications due to CVD is further magnified in patients with diabetes and obesity.

NAFLD and heart failure

Fat accumulation in the liver is associated with excess fat surrounding the heart. In patients with NAFLD, the fat surrounding the heart can induce inflammation and fibrosis resulting in a stiff heart. Even when a stiff heart can pump blood normally (preserved ejection fraction), the heart chambers can becometoo stiff to relax and fill properly which can result in heart failure1.  This condition is commonly referred to as diastolic heart failure or heart failure with preserved ejection fraction(HFpEF), and is associated with NAFLD.

Diagnosing NAFLD:

Many patients with NAFLD do not show any symptoms and therefore remain undiagnosed.

The ‘gold-standard’ for diagnosing fatty liver disease for most clinicians is a needle biopsy which analyzes 1/50,000th of the entire liver

Needle biopsies are invasive, involve some risk, expensive and do not sample the entire liver.

We were confident that there was a better way to conduct screenings for such a prevalent, and potentially life-threatening, disease. If your physician suspects compromise to your liver health, LHI has made it easier to evaluate liver health using an MRI based non-invasive imaging test (Liver Health Imaging package) that provides objective evaluation of liver fat content, liver iron and estimate of liver fibrosis This single scan utilizes sophisticated MRI technologies to provide quantified reports on the liver – providing details on liver anatomy, liver fat, liver iron, and liver fibrosis. This exam provides extremely precise information in a cost-effective environment so that patients have a chance to reverse the disease before it progresses into cardiovascular disease, or worse.

Visit our Liver Health Imaging page to learn more.


1. Chiriac S, Stanciu C, Girleanu I, et al. Nonalcoholic Fatty Liver Disease and Cardiovascular Diseases: The Heart of the Matter. Can J Gastroenterol Hepatol. 2021;2021:6696857. doi:10.1155/2021/6696857
2. Kasper P, Martin A, Lang S, et al. NAFLD and cardiovascular diseases: a clinical review. Clin Res Cardiol. 2021;110(7):921-937. doi:10.1007/s00392-020-01709-7