Fatty Liver Raises Heart Disease Risk by 63% — and Heart Failure Risk Nearly Four-Fold

NAFLD / MASLD and Cardiac Risk?

Two diseases are building inside you right now and neither of these 2 diseases will send you a symptom at first.

The first is fatty liver / NAFLD / MASLD. No pain. No nausea. No warning. No Symptoms. Liver fills with fat silently for years, sometimes decades. Almost 25% of Indians have it. Most have no idea – including you and me, unless we are outliers and specifically go for MASLD / NAFLD relevant tests pretty regularly.

The second is cardiovascular disease. Your arteries stiffen. Plaque keeps building. Endothelial cells are damaged. You feel nothing, no apparent symptoms. Your blood pressure looks apparently normal. Your doctor says “everything looks fine.”

Now here is the fact which ties both these diseases together: people with fatty liver / NAFLD / MASLD do not primarily die of liver failure. They die of heart attacks.

You may not read it twice, hence we are repeating it, at the risk of being ridiculed – people with fatty liver / NAFLD / MASLD do not primarily die of liver failure. They die of heart attacks.

Where is the Evidence

A large 2024 analysis of more than 10.6 million young people links fatty liver disease with higher risks of heart disease, heart attack, stroke and heart failure Fatty liver is often and still is being treated / considered as a liver problem. Scientific evidence now shows why this view is incomplete and erroneous.

A major systematic review and meta-analysis published in Frontiers in Cardiovascular Medicine in January 2024 examined four cohort studies, 11 datasets and 10,668,189 young adults and children. The researchers found that people with non-alcoholic fatty liver disease, or NAFLD, had a 63% higher overall risk of cardiovascular disease.

You can download a copy of this published article here – Fatty Liver increases risk of cardiovascular diseases significantly

Fatty liver linked with several major heart problems

The findings become more concerning when individual heart conditions are examined. The study reported the following risks in people with NAFLD:

These results came from studies with average follow-up periods ranging from 7.4 to 16.6 years.

The strongest signal was seen for heart failure, where NAFLD was associated with a nearly four-fold higher risk. The confidence interval for this estimate was wide, so the exact size of the risk remains uncertain.

Why does fatty liver affect the heart?

The liver is deeply connected with the way the body handles sugar and fat.

NAFLD commonly occurs alongside insulin resistance, abdominal obesity, high triglycerides, type 2 diabetes and high blood pressure. Researchers also point to long-term inflammation and changes in blood vessels as possible links between fatty liver and heart disease.

In simple terms, fat in the liver can be a warning sign of a much wider metabolic problem affecting the whole body, should you care to listen and act.

The danger is appearing in younger people

One of the most important findings of the 2024 analysis is the age of the people studied.

Three included studies examined adults aged 18 to 40 years. Another study followed children and young people with an average age of about 17 years.

The studies covered populations in Germany, South Korea and Sweden – THE DEVELOPED COUNTRIES – and included more than 10.6 million people.

This challenges the belief that fatty liver and cardiovascular disease are problems mainly seen after middle age.

Why fatty liver is particularly important for India

India has a major fatty liver burden. A widely cited Indian systematic review and meta-analysis estimated that around 38.6% of Indian adults may have NAFLD, although prevalence varies greatly according to the population and diagnostic method studied.

For India, the combination of abdominal obesity, diabetes, insulin resistance and fatty liver deserves particular attention.

A person may have fatty liver without severe liver symptoms. Yet the underlying metabolic changes may already be increasing long-term heart risk.

Another 2024 study strengthens the fatty liver–heart link

Research published in Frontiers in Endocrinology in July 2024 followed 4,226 participants from the Multi-Ethnic Study of Atherosclerosis.

People with NAFLD had a 58% higher adjusted risk of developing calcium deposits in the aortic valve compared with people without NAFLD. This is important because calcium build-up in the aortic valve can eventually affect how blood leaves the heart.

The study also found genetic evidence linking some measures of fatty liver with severe aortic valve disease, although the genetic findings were not consistent across every analysis.

Can fatty liver and heart risk be reduced?

For many people, early fatty liver can improve.

Weight reduction, regular physical activity, better blood sugar control and improvements in diet are central to managing NAFLD.

The aim is not simply to “remove fat from the liver”. The bigger goal is to improve insulin sensitivity, blood pressure, blood fats and overall cardiovascular health.

Your fatty liver is not JUST a liver problem. It is a signal that the same metabolic dysfunction destroying your liver is simultaneously destroying your arteries and raising your risk of Cardio Vascular Disease. One engine. Two organs. Zero symptoms.

Until the heart attack that “came out of nowhere.” Well – It didn’t come out of nowhere. It did come from a liver full of fat but nobody connected it with Heart issues. 

If ever you eat outside food, laden with seed oils, and have relatively lesser active lifestyle than you aspire – pls spend INR 1,000 for a detailed Liver Function Test – You May Do Yourself a Hearty Good Favour.