VanWagner LB, Wilcox JE, Ning H, et al. - Given the link of non-alcoholic fatty liver disease (NAFLD) with high cardiovascular morbidity/mortality, including heart failure, and the link of abnormalities in left ventricular (LV) structure/function with heart failure risk, researchers explored this subject by performing an inquiry among participants from the population-based CARDIA (Coronary Artery Risk Development in Young Adults) study year 25 exam (2010–2011, aged 43–55 years, 61% women, 48% black). These participants had undergone computed tomography to measure liver fat and comprehensive echocardiography. Higher LV mass, relative wall thickness, incident LV hypertrophy and abnormal LV geometry was evident among NAFLD participants vs non-NAFLD. Impaired LV relaxation, higher LV filling pressures, worse longitudinal strain, and lower LV ejection fraction, was detected in NAFLD participants. An independent link of NAFLD with incident LV hypertrophy, abnormal LV geometry and greater change in strain was revealed in multivariable analyses adjusted for heart failure risk factors. The links were attenuated to non-significance after adjustment for body mass index. Overall, findings revealed the association of NAFLD with subclinical alterations over time in LV structure/function and much of the link was explained by obesity. The recognition of a crucial at-risk population, that is a suitable candidate for implementing preventive heart failure strategies, may be enabled by the presence of obesity in mid-life.