Top Things to Know: Nonalcoholic Fatty Liver Disease and Cardiovascular Risk

Published: April 14, 2022

  1. Nonalcoholic fatty liver disease (NAFLD) is common, affecting more than 25% of adults worldwide, with rates increasing everywhere in association with rising rates of obesity and metabolic syndrome.
  2. This scientific statement highlights the pathophysiology, association of NAFLD with CVD, diagnostic strategies, and potential interventions for NAFLD.
  3. NAFLD is a risk factor for atherosclerotic cardiovascular disease (ASCVD), which is the principal cause of death in patients with NAFLD. In addition, hepatic complications from NAFLD include non-alcoholic steatohepatitis (NASH), hepatic cirrhosis and hepatocellular carcinoma. NASH is a common cause of end stage liver disease.
  4. Most patients with NAFLD are undiagnosed. The underdiagnosis of NAFLD is a primary barrier to optimal medical management and interferes with assessment of disease prevalence and complications.
  5. Measurements of hepatic aminotransferase levels in plasma and liver ultrasonography are commonly used screening tools but lack sensitivity for diagnosis and monitoring of NAFLD. Thus, improved diagnostic strategies for identification of NAFLD are needed. Available non- invasive diagnostic options are underutilized, such as vibration-controlled transient elastography (Fibroscan).
  6. Lifestyle modification is the key intervention for patients with NAFLD and NASH, with a focus on sustainably reducing adiposity, improving insulin sensitivity, and reducing cardiometabolic risk factors associated with the metabolic syndrome.
  7. GLP-1 receptor agonists may modestly improve NAFLD in association with improved glycemia, weight loss, and reduced risk of major adverse cardiovascular events.
  8. Novel experimental drug therapies that target various steps in the pathogenesis of NAFLD are in development, but most have modest efficacy and toxicity has been a limiting factor for some agents.
  9. This scientific statement includes an informational handout about NAFLD that is available for patient education as an online supplement. The scientific statement also includes key take home messages for health care professionals.
  10. By increasing awareness of NAFLD, facilitating better access to reliable imaging tools for screening and monitoring, and fostering the development of treatment tools, the rising tide of NASH can be reversed and adverse ASCVD outcomes prevented.


Duell PB, Welty FK, Miller M, Chait A, Hammond G, Ahmad Z, Cohen DE, Horton JD, Pressman GS, Toth PP; on behalf of the American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Hypertension; Council on the Kidney in Cardiovascular Disease; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease. Nonalcoholic fatty liver disease and cardiovascular risk: a scientific statement from the American Heart Association. [published online ahead of print April 14, 2022]. Arterioscler Thromb Vasc Biol. doi: 10.1161/ATV.0000000000000153