Detecting and treating undiagnosed nonalcoholic fatty liver disease (NAFLD) could lead to improvements in cardiovascular health, according to a new statement form the American Heart Association — highlighting the ways that metabolic and cardiovascular health are closely related.
NAFLD is characterized by elevated levels of fat in liver tissue, which can eventually lead to reduced liver function and, in the most severe cases, liver failure — potentially causing death. But even if it doesn’t reach a point where your liver function is severely reduced, NAFLD is linked to several poor health outcomes, especially in people with diabetes. In people with type 2 diabetes, NAFLD is linked to a higher risk for severe hypoglycemia (low blood glucose), a dangerous condition that requires emergency medical attention. NAFLD is also linked to developing diabetes in the first place, and people with NAFLD are at a higher risk of death from all causes, especially at more advanced stages of liver disease. Unfortunately, undiagnosed liver disease appears to be very common in people with type 2 diabetes. There are likely several factors behind a person’s risk for NAFLD, including their family history of diabetes and unhealthy dietary patterns. Likewise, there are certain lifestyle measures that may help you prevent NAFLD — including some as simple as drinking coffee regularly.
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In the latest statement, the American Heart Association notes that NAFLD is an increasingly common condition that is believed to affect more than 25% of adults worldwide — with estimates for people with diabetes running much higher. But unless specific testing is performed to identify NAFLD, it tends to remain a “silent,” undetected condition until it progresses to a severe stage, when much less can be done to address the condition. In addition to being related to a number of health conditions outside the liver, NAFLD can cause severe and sometimes irreversible damage to the liver — including steatohepatitis (a form of inflammation), hepatic cirrhosis (liver “scarring”), and hepatocellular carcinoma (liver cancer).
NAFLD and cardiovascular disease linked
But the main focus of the statement is how NAFLD is related to cardiovascular disease, especially atherosclerotic disease, in which fatty deposits (called plaque) build up inside the lining of blood vessels. Atherosclerotic cardiovascular disease is linked to a number of severe conditions and events, including coronary artery disease (CAD), in which blood flow to the heart is reduced, as well as heart attack and stroke. It turns out, in fact, that cardiovascular disease is a leading cause of death in people with NAFLD. Both liver disease and cardiovascular disease are linked to rising rates of obesity and metabolic syndrome — a group of health conditions linked to chronic disease, including type 2 diabetes.
The statement notes that NAFLD appears to be an independent risk factor for atherosclerotic cardiovascular disease — meaning that even after adjusting for other known risk factors like high blood pressure, greater body weight, and older age, people with NAFLD are at greater risk for cardiovascular disease and its complications.
One reason why many cases of NAFLD remain undiagnosed, the statement notes, is that people with NAFLD can have normal results in tests of liver enzyme levels. And the “gold standard” test for identifying NAFLD, a liver biopsy, is invasive and expensive. But there are other less invasive tests that can help identify NAFLD in people with normal liver enzyme levels, including vibration-controlled transient elastography (often known by the brand name FibroScan). But developing new screening tools may be needed to have a meaningful impact on rates of undiagnosed NAFLD.
While GLP-1 receptor agonists — a group of drugs developed to lower blood glucose levels in type 2 diabetes — may be helpful in treating NAFLD, the statement emphasizes that lifestyle interventions are the most effective way to address the condition, as described in an article on the statement at Healio. Steps that the American Heart Association recommends include dietary changes, greater physical activity, weight loss, and avoiding alcohol — steps that may also carry the benefit of reducing the risk for complications of cardiovascular disease.
Want to learn more about protecting your liver? Read “Diabetes and NAFLD” and “Preventing Fatty Liver (NAFLD).”