Fatty liver disease stronger independent indicator of cardiovascular disease than age, smoking, gender, or other traditional risk factors

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the United States and other Western countries, affecting up to a third of the general population, and in most cases causing no signs or symptoms. NAFLD is the most common cause for cirrhosis and a common cause for primary liver cancer. Most affected individuals are completely unaware of their liver disease.

Now Saint Luke’s liver specialists and cardiologists have discovered a compelling association between NAFLD and a high risk for cardiovascular disease. The link between the two was stronger than other more traditional risk factors for coronary artery disease such as smoking, hypertension, male gender, diabetes, high cholesterol, or metabolic syndrome. The research findings are published in an online article in the Mayo Clinic Proceedings posted Oct. 16, 2013.

The research study was a collaborative partnership between Saint Luke’s Liver Disease Management Center gastroenterologists Rajiv Chhabra, M.D., and John Helzberg, M.D., and Saint Luke’s Mid America Heart Institute cardiologists James O’Keefe, M.D., and Randall Thompson, M.D.

The study assessed upper abdominal CT images from 377 non-symptomatic patients undergoing non-contrast CT scans to determine coronary calcium scores. Using expanded imaging “windows” to include the liver and spleen, researchers found that patients with fatty liver disease were more likely to also have coronary artery disease. The research is compelling enough that cardiologists at Saint Luke’s are considering changing their practices to include liver and spleen images in CT scans as a screening indicator of coronary artery disease risk. 

Non-alcoholic fatty liver disease is the accumulation of fat in the liver in people who drink little to no alcohol. The fat can cause inflammation and scarring in the liver. Its most serious form can progress to cirrhosis, liver failure, or liver cancer. It is the most common liver disorder in Western countries and one of the fastest growing concerns among clinicians due to an escalating patient population with obesity and diabetes.  

“If current trends continue, the prevalence of NAFLD is expected to increase to 40 percent of the population by 2020,” said Dr. Helzberg. “This discovery is important in identifying potential cardiovascular disease in NAFLD patients. Hopefully future research will yield better treatment options and disease management.”  Treatments now primarily include lifestyle changes such as diet, exercise, and increased monitoring. 

While more research is needed to explore the relationship between the two conditions, the growing number of patients with NAFLD suggests a potential role for increased screening among the medical community. “These findings suggest that patients with coronary artery disease should possibly be screened for liver disease. Likewise, NAFLD patients should be evaluated for coronary artery disease,” said Dr. Chhabra.

Funding was provided through a research grant to Dr. Helzberg from the Saint Luke’s Foundation and the Mid America Heart Institute Foundation.

“This study is another example of what can arise from cross-disciplinary collaboration that is increasingly common at Saint Luke’s. By pooling our knowledge and insights, we are able to identify promising areas for research that may have a powerful impact on our ability to practice medicine and to improve the lives of our patients,” said David J. Cohen, M.D., M.Sc., director of Cardiovascular Research at Saint Luke’s Hospital.