Byrne CD, Tangier G, et al. - The complex interplay between the liver and cardiometabolic risk factors contributes to cardiovascular disease (CVD), arrhythmias, and cardiac disease in non-alcoholic fatty liver disease (NAFLD). A multidisciplinary approach is urgently needed to manage both liver disease and cardiometabolic risk, and investigate the cardiovascular and cardiac effects of new drugs for NAFLD.

• The results showed that NAFLD is correlated with an elevated risk of fatal/non-fatal CVD events and other cardiac and arrhythmic complications (left ventricular hypertrophy, aortic-valve sclerosis, and certain arrhythmias), independently of common CVD risk factors.

• Researchers may include several underlying mechanisms, involving hepatic/systemic insulin resistance, atherogenic dyslipidemia, hypertension, and pro-atherogenic, pro-coagulant, and pro-inflammatory mediators released from the steatotic/inflamed liver.

• It has been considered that some genetic polymorphisms, such as PNPLA3 (rs738409 C>G) and TM6SF2 (rs58542926 C>T), may worsen the liver disease, but also attenuate the strength of the relationship between NAFLD and CVD, possibly via their effects on lipoprotein metabolism.

• Pioglitazone and GLP-1 receptor agonists are the most promising out of the currently tested drugs for treating NAFLD that also benefit the vasculature.