De-liver-ing news about the heart

The prevalence of fatty liver disease (FLD) is increasing and is a growing public health issue.

As the rates of obesity, type 2 diabetes, and high cholesterol are rising in the United States, so is the rate of FLD. Currently, fatty liver disease affects about 25% of people in the world, and it is actually the most common chronic liver disorder in the United States. 

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Unfortunately, FLD is usually a silent disease with few or no symptoms. Sometimes it causes abnormalities in blood tests that are referred to as “liver enzymes”. Oftentimes, it is found accidentally on a CAT scan or ultrasound being performed for other purposes. 

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Left untreated and unchecked, FLD can lead to liver cirrhosis (even in the absence of a history of drinking alcohol) and liver cancer. 

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In recent years, it has been recognized more and more that this condition can be the result of metabolic abnormalities, including diabetes, insulin resistance, and obesity. In fact, there is an effort underway to rename the problem as Metabolic-Associated Fatty Liver Disease (“MAFLD”) in order to differentiate it from fatty liver disease caused by drinking or other problems.

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Because we already know that unhealthy metabolic status is associated with heart problems, it should come as no surprise that cardiovascular disease (CVD) is also a major concern in people with fatty liver disease. Studies have reported relationships between fatty liver disease accompanied by unhealthy metabolic status (“MAFLD”) and a higher incidence of atherosclerotic cardiovascular disease, such as heart attack, angina, and stroke.

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This “unhealthy metabolic status” was defined by any of the following conditions: diabetes mellitus, being overweight, or the presence of something called metabolic syndrome, which itself is a mixture of high blood pressure, high waist circumference, high triglycerides, low HDL (“good cholesterol”) and high blood sugars.

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In a recently published study, MAFLD was associated with development of heart failure and atrial fibrillation. In this recent study of over 4.2 million people in Japan, the incidence of heart failure and AFib events was lowest in the healthiest non-FLD/non-metabolic dysfunction group, and highest in the metabolic-associated FLD group.

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Similarly, the cumulative incidence of heart attack, chest pain/angina, and stroke, was the highest in the metabolic-associated FLD group, and lowest in the healthy non-FLD/ non-metabolic dysfunction group.

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In fact, the presence of metabolic-associated FLD was associated with a 35% higher risk of developing atherosclerotic heart disease, including acute MI, coronary artery disease, and plaque in the arteries that supply the brain.

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Why is this so important? Because of the typical unhealthy lifestyle habits (physical inactivity, sedentary lifestyle, and excess calorie intake) which are characteristic of modern society, the rates of metabolic-associated FLD (MAFLD) are expected to increase further. Which means even more lives lost due to heart disease. For most of the last 20 years, the rate of deaths from heart disease had steadily declined. Unfortunately, in the last few years, we have been seeing an upswing of heart disease deaths, as the epidemics of diabetes and obesity are spreading.

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The silver lining: Eating a healthy whole food, plant-based diet and exercising regularly can reverse fatty liver disease and these awful population trends.

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At Wisconsin Cardiology Associates, we encourage and emphasize the use of lifestyle interventions to achieve better health results.

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Ohno R et al. JACC:Asia 10/10/23