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Extrahepatic complications of liver fat
NAFLD, PRE-ATHEROGENIC LESIONS AND
CARDIOVASCULAR EVENTS
Sven M.A. Francque
Faculty of Medicine and Health Sciences,
University of Antwerp, Antwerp, Belgium
Email: sven.francque@uantwerpen.be
Take-home messages
• Increasing evidence points towards an increased risk of CVD in patients with NAFLD, independently
of classical, metabolic risk factors.
• The pathophysiology of the link between NAFLD and CVD is complex and involves several potential
mechanisms.
• It is currently unclear whether the increased risk of CVD in relation to NAFLD is confined to NASH
or also applies to patients with NAFL.
• The need for screening and the impact of treatment of NAFLD on the risk of CVD are currently
unknown.
Introduction
Besides the associated liver-related morbidity and mortality, it has become clear that NAFLD is also
associated with an increased risk of CVD.The link between NAFLD and CVD can in part be explained
by the common risk factors that they share. However, there is growing evidence that NAFLD is an
etiological factor contributing to the development of CVD, independently of classical known risk factors
for the latter.
NAFLD and CVD
Data is accumulating that patients affected by NAFLD have a higher risk of developing CV
abnormalities, clinical CV events and even CV death. A first specific challenge in the interpretation of
this data on the link between CVD and NAFLD is to distinguish between a timely correlation, simply
based on underlying risk factors that are shared by both conditions, or an independent contribution
of NAFLD (after correction for these shared metabolic risk factors) in the subsequent development
of CVD. The latter implies a specific pathophysiological contribution of the liver affected by NAFLD
to the development of CV abnormalities. Elucidating the role of NAFLD in the development of CVD
therefore constitutes a second challenge, in which, besides clinical data, studies in animal models might
be helpful. Finally the question of whether the role of NAFLD in the development of CVD is confined
to NASH or is already present in NAFL needs to be answered. This question is particularly relevant for
the treatment of NAFLD. If indeed the development of CVD is substantially influenced by NAFLD and
NASH, its prevention might constitute an indication to treat NAFLD and its subtypes.
NAFLD and CVD: clinical data
Data have been recently reviewed [1-3]. The most convincing data on the role of NAFLD in CVD
are those on the link between NAFLD and subclinical CHD. Both in cross-sectional and in follow-
up studies, NAFLD, mostly diagnosed by ultrasound, has been shown to be an independent risk
factor (after correction for classical risk factors for CHD) for: the presence or future development of
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 59
NAFLD, PRE-ATHEROGENIC LESIONS AND
CARDIOVASCULAR EVENTS
Sven M.A. Francque
Faculty of Medicine and Health Sciences,
University of Antwerp, Antwerp, Belgium
Email: sven.francque@uantwerpen.be
Take-home messages
• Increasing evidence points towards an increased risk of CVD in patients with NAFLD, independently
of classical, metabolic risk factors.
• The pathophysiology of the link between NAFLD and CVD is complex and involves several potential
mechanisms.
• It is currently unclear whether the increased risk of CVD in relation to NAFLD is confined to NASH
or also applies to patients with NAFL.
• The need for screening and the impact of treatment of NAFLD on the risk of CVD are currently
unknown.
Introduction
Besides the associated liver-related morbidity and mortality, it has become clear that NAFLD is also
associated with an increased risk of CVD.The link between NAFLD and CVD can in part be explained
by the common risk factors that they share. However, there is growing evidence that NAFLD is an
etiological factor contributing to the development of CVD, independently of classical known risk factors
for the latter.
NAFLD and CVD
Data is accumulating that patients affected by NAFLD have a higher risk of developing CV
abnormalities, clinical CV events and even CV death. A first specific challenge in the interpretation of
this data on the link between CVD and NAFLD is to distinguish between a timely correlation, simply
based on underlying risk factors that are shared by both conditions, or an independent contribution
of NAFLD (after correction for these shared metabolic risk factors) in the subsequent development
of CVD. The latter implies a specific pathophysiological contribution of the liver affected by NAFLD
to the development of CV abnormalities. Elucidating the role of NAFLD in the development of CVD
therefore constitutes a second challenge, in which, besides clinical data, studies in animal models might
be helpful. Finally the question of whether the role of NAFLD in the development of CVD is confined
to NASH or is already present in NAFL needs to be answered. This question is particularly relevant for
the treatment of NAFLD. If indeed the development of CVD is substantially influenced by NAFLD and
NASH, its prevention might constitute an indication to treat NAFLD and its subtypes.
NAFLD and CVD: clinical data
Data have been recently reviewed [1-3]. The most convincing data on the role of NAFLD in CVD
are those on the link between NAFLD and subclinical CHD. Both in cross-sectional and in follow-
up studies, NAFLD, mostly diagnosed by ultrasound, has been shown to be an independent risk
factor (after correction for classical risk factors for CHD) for: the presence or future development of
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 59
