Fatty liver disease, also known as hepatic steatosis, happens when too much fat builds up inside the liver.
It has become very common because of rising rates of obesity, type 2 diabetes, and unhealthy diets.
Many people have no symptoms, so they may not know they have the condition until it is found during a medical scan or blood test.
Doctors have long known that fatty liver disease can increase the risk of serious liver problems if it becomes more severe. In recent years, scientists have also started to discover that the condition may affect much more than the liver.
Growing evidence suggests it may also increase the risk of heart disease, which is the leading cause of death in people with fatty liver disease.
A new study from the Mass General Brigham Heart and Vascular Institute provides more evidence of this connection.
The research was published in the journal Clinical Gastroenterology and Hepatology. The findings suggest that a routine heart CT scan may reveal important clues about both liver health and future heart disease risk.
The researchers studied 3,637 people who took part in the large PROMISE trial, a multicenter study involving patients who were being assessed for chest pain. During cardiac CT scans, part of the liver is often visible, allowing the team to identify people with fatty liver disease while also examining their heart arteries.
More than one quarter of the participants had fatty liver disease. The CT scans showed that these people were more likely to have larger amounts of noncalcified plaque inside their coronary arteries. This softer type of plaque is considered more dangerous because it is more likely to break open, form a blood clot, and trigger a heart attack.
Compared with participants without fatty liver disease, people with the condition had a 24% higher amount of noncalcified plaque and a 15% higher overall plaque burden. These differences suggested that fatty liver disease may be linked to earlier and more dangerous changes inside the heart’s blood vessels.
The researchers continued following participants for a median of about 25 months. During this time, people with fatty liver disease experienced major cardiovascular events, including heart attack, death, or hospitalization for unstable angina, almost twice as often as those without fatty liver disease.
Even after taking into account age, blood pressure, cholesterol, diabetes, and other well-known heart disease risks, fatty liver disease was still linked to a 69% higher chance of a major cardiovascular event. The study also found that dangerous noncalcified plaque explained part of this extra risk, suggesting it may be one of the important biological links between liver disease and heart disease.
Lead author Dr. Jan Brendel said fatty liver disease should not be viewed as only a liver condition. Because it can often be seen on routine cardiac CT scans, doctors may be able to identify patients who need stronger preventive care before serious heart problems develop. Future studies will investigate whether treatments such as high-intensity statins or GLP-1 receptor agonists can lower high-risk plaque in these patients.
This study has several strengths, including its large number of participants and the use of detailed CT imaging. However, it was an observational study, meaning it found an association rather than proving that fatty liver disease directly causes heart disease.
Even so, the findings add to growing evidence that fatty liver disease is an important warning sign for cardiovascular health and support earlier screening and prevention for people living with the condition.
If you care about heart health, please read studies about top foods to love for a stronger heart, and why oranges may help fight obesity, diabetes, and heart disease.
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Source: Mass General Brigham.
