Heart failure risk increased in patients with NAFLD, meta-analysis finds

Nonalcoholic fatty liver disease (NAFLD) is associated with increased risk of new-onset heart failure (HF), a recent meta-analysis found.

Researchers searched databases through March 2022 and found 11 longitudinal cohort studies with data on NAFLD diagnoses among 11,242,231 middle-age individuals from different countries and 97,716 cases of incident HF over a median of 10 years of follow-up. Results were published by Gut on July 25.

The analysis found that NAFLD was associated with higher risk of new-onset HF (pooled random-effects hazard ratio, 1.50 [95% CI, 1.34 to 1.67]; P<0.0001). The association was independent of age, sex, ethnicity, adiposity, diabetes, hypertension, and other common cardiovascular risk factors. The risk of HF was further elevated with greater severity of NAFLD, especially higher fibrosis stage, the authors noted.

“To our knowledge, our meta-analysis assessing the association between NAFLD and the long-term risk of new-onset HF is the largest and most comprehensive assessment of this association to date,” said the authors, who noted that explaining the association was outside the scope of the review but that there are “probably several pathophysiological mechanisms by which NAFLD increases the risk of cardiac (functional, structural and arrhythmic) complications that may promote the development of HF.”

The authors called for future studies to assess potential genetic associations as well as to test whether medications can reduce the risk of HF in patients with NAFLD. In the meantime, the results “further highlight the need for a patient-centred, multidisciplinary and holistic approach to manage both liver disease and cardiovascular risk in people with NAFLD,” the study authors said.