NAFLD and cardiovascular disease: Can the real association be determined?

Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of liver diseases ranging from isolated hepatic steatosis (IHS) to non-alcoholic steatohepatitis (NASH) defined by the presence of hepatocellular injury, and may progress to end-stage liver disease and its complications. Mounting evidence also suggests that direct effects on the heart may explain why cardiovascular disease (CVD), comprising coronary artery disease and cerebrovascular disease, is the leading cause of death among individuals with NASH. CVD and NASH share common risk factors, however NASH may increase atherogenic risk or alter cardiac function independent of these commonalities. A complex interplay between an inflamed visceral fat compartment, the liver and the endothelium creates a pro-inflammatory, procoagulant and pro-atherogenic milieu that can contribute to accelerated atherosclerosis and cardiac dysfunction. While new evidence is accumulating that might help close the gap in our understanding of the putative role of NASH in CVD, more prospective data are still needed.