A Scientific Statement From the AHA on CV Risk in Nonalcoholic Fatty Liver Disease

Bad died and nonalcoholic fatty liver disease concept with a liver and sugar cubes, nafld is caused by high levels of fructose accumulated in the liver that can lead to cirrhosis and diabetes
The American Heart Association has issued a scientific statement regarding the relationship between nonalcoholic fatty liver disease and cardiovascular risk.

The American Heart Association (AHA) has published a scientific statement in Arteriosclerosis, Thrombosis, and Vascular Biology, regarding cardiovascular risk in nonalcoholic fatty liver disease (NAFLD).

NAFLD is a common disorder affecting over 25% of adults worldwide. Its prevalence is lowest in Africa (13.5%) and highest in the Middle East (32%) and South Asia (33%). In the United States, it occurs most frequently among the Hispanic population (21%).

However, these rates likely do not represent the true prevalence, as underdiagnosis of NAFLD is common and represents the primary barrier to proper medical management.

Risk for NAFLD overlaps with many aspects of metabolic syndrome, but the 2 conditions can manifest on their own. Lifestyle, such as dietary habits, can aggravate risk factors for NAFLD.

Beyond lifestyle factors, some risk has been attributed to genetic factors. Evidence, such as the worldwide variation, supports the likelihood that genetic variants which are more common in some regions predispose certain populations to develop NAFLD.

The leading cause of death among patients with NAFLD is cardiovascular disease (CVD), therefore NAFLD is an important aspect in CVD prevention. In addition, NAFLD is an independent risk factor for atherosclerotic CVD and in general, patients with NAFLD tend to have elevated CVD risk.

For accurate diagnosis of NAFLD, the statement authors recommend hepatic ultrasonography, vibration-controlled transient elastography, computed tomography, and magnetic resonance imaging approaches be used. Clinicians should be aware that it remains difficult to predict which patients will progress from NAFLD or nonalcoholic steatohepatitis (NASH) to liver hepatic steatosis.

Once NAFLD is diagnosed, the 3 main goals of NAFLD management include preserving liver function, preventing cardiovascular complications, and preventing or treating metabolic complications. Much of these goals can be achieved through lifestyle modification by reducing adiposity through diet and exercise and preventing liver damage by avoiding excess alcohol consumption.

In the event that patients require pharmacotherapy intervention, glucagon-like peptide 1 receptor agonists may improve glycemia associated with NAFLD. In addition, there are currently novel therapeutics being developed for NAFLD.

The statement authors wrote, “NAFLD and NASH are increasingly common conditions that are underdiagnosed and underappreciated as risk factors for ASCVD morbidity and mortality. […] It is hoped that with increased awareness of NAFLD, better access to reliable imaging tools for screening and monitoring for NAFLD, and proven tools for the treatment of NAFLD, the rising tide of NASH and more advanced hepatic disease can be reversed and adverse ASCVD outcomes prevented.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Duell PB, Welty FK, Miller M, et al. Nonalcoholic fatty liver disease and cardiovascular risk: A scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol. Published online April 14, 2022. doi:10.1161/ATV.0000000000000153