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Association between Cardiovascular Disease and Liver Disease, from a Clinically Pragmatic Perspective as a
Mitsutaka Nakashima1, Kazufumi Nakamura1, Takahiro Nishihara1
1Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan.
Insights
Cardiovascular and liver diseases are linked, with non-alcoholic fatty liver disease impacting heart health. Liver fibrosis is a marker for heart failure prognosis, highlighting the need for integrated management strategies.
Area of Science:
- Cardiology
- Hepatology
- Internal Medicine
Background:
- Cardiovascular diseases and liver diseases share common risk factors and exhibit bidirectional interactions.
- Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized as both a risk factor for and a consequence of atherosclerotic cardiovascular disease (ASCVD).
- Heart failure can precipitate liver fibrosis, while liver fibrosis exacerbates cardiac dysfunction through altered preload and congestion.
Purpose of the Study:
- To review the complex associations between cardiovascular diseases and liver diseases.
- To explore the prognostic implications of liver fibrosis in patients with cardiovascular conditions.
- To highlight the current gaps in established management strategies for liver disease in patients with co-existing cardiovascular disease.
Main Methods:
- Literature review summarizing existing research on the interplay between cardiovascular and liver diseases.
- Analysis of studies investigating non-alcoholic fatty liver disease (NAFLD) and atherosclerotic cardiovascular disease (ASCVD) risk.
- Evaluation of evidence linking heart failure, liver fibrosis, and patient outcomes.
Main Results:
- Liver fibrosis progression in non-alcoholic fatty liver disease (NAFLD) correlates with poorer cardiovascular prognosis.
- Liver fibrosis serves as a significant prognostic marker in patients diagnosed with heart failure.
- Non-invasive markers like liver stiffness (shear wave elastography), FIB-4 index, and NAFLD fibrosis score are associated with liver fibrosis severity and adverse cardiovascular outcomes.
Conclusions:
- The relationship between cardiovascular and liver diseases is intricate, necessitating a comprehensive understanding for effective patient care.
- Liver fibrosis is a critical indicator of prognosis in both liver and heart conditions, emphasizing the need for its accurate assessment.
- Further research is crucial to determine if interventions targeting liver disease can improve cardiovascular outcomes, especially in an aging population.
Abstract:
Cardiovascular diseases and liver diseases are closely related. Non-alcoholic fatty liver disease has the same risk factors as those for atherosclerotic cardiovascular disease and may also be a risk factor for atherosclerotic cardiovascular disease on its own. Heart failure causes liver fibrosis, and liver fibrosis results in worsened cardiac preload and congestion. Although some previous reports regard the association between cardiovascular diseases and liver disease, the management strategy for liver disease in patients with cardiovascular diseases is not still established. This review summarized the association between cardiovascular diseases and liver disease. In patients with non-alcoholic fatty liver disease, the degree of liver fibrosis progresses with worsening cardiovascular prognosis. In patients with heart failure, liver fibrosis could be a prognostic marker. Liver stiffness assessed with shear wave elastography, the fibrosis-4 index, and non-alcoholic fatty liver disease fibrosis score is associated with both liver fibrosis in patients with liver diseases and worse prognosis in patients with heart failure. With the current population ageing, the importance of management for cardiovascular diseases and liver disease has been increasing. However, whether management and interventions for liver disease improve the prognosis of cardiovascular diseases has not been fully understood. Future investigations are needed.
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