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World J Gastroenterol. Feb 21, 2014; 20(7): 1724-1745
Published online Feb 21, 2014. doi: 10.3748/wjg.v20.i7.1724
Risk of cardiovascular, cardiac and arrhythmic complications in patients with non-alcoholic fatty liver disease
Stefano Ballestri, Amedeo Lonardo, Stefano Bonapace, Christopher D Byrne, Paola Loria, Giovanni Targher
Stefano Ballestri, Division of Internal Medicine, Pavullo Hospital, 41026 Pavullo, Italy
Stefano Ballestri, Amedeo Lonardo, Paola Loria, Department of Biomedical, Metabolic and Neural Sciences, Division of Internal Medicine NOCSAE, University of Modena and Reggio Emilia and Azienda USL, Baggiovara, 41126 Modena, Italy
Stefano Bonapace, Division of Cardiology, “Sacro Cuore” Hospital, 37024 Negrar, Italy
Christopher D Byrne, Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton SO16 6YD, United Kingdom
Giovanni Targher, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy
Author contributions: Targher G conceived the hypothesis and the outline of the manuscript; Ballestri S, Lonardo A and Targher G researched the data, analyzed the data and wrote the manuscript; Bonapace S, Byrne CD and Loria P contributed to discussion and reviewed/edited the manuscript.
Supported by (in part) the Southampton National Institute for Health Research Biomedical Research Centre (Byrne CD); grants from the School of Medicine of the Verona University (Targher GT)
Correspondence to: Giovanni Targher, MD, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126 Verona, Italy. giovanni.targher@univr.it
Telephone: +39-45-8123748 Fax: +39-45-8027314
Received: September 30, 2013
Revised: October 30, 2013
Accepted: November 18, 2013
Published online: February 21, 2014
Abstract

Non-alcoholic fatty liver disease (NAFLD) has emerged as a public health problem of epidemic proportions worldwide. Accumulating clinical and epidemiological evidence indicates that NAFLD is not only associated with liver-related morbidity and mortality but also with an increased risk of coronary heart disease (CHD), abnormalities of cardiac function and structure (e.g., left ventricular dysfunction and hypertrophy, and heart failure), valvular heart disease (e.g., aortic valve sclerosis) and arrhythmias (e.g., atrial fibrillation). Experimental evidence suggests that NAFLD itself, especially in its more severe forms, exacerbates systemic/hepatic insulin resistance, causes atherogenic dyslipidemia, and releases a variety of pro-inflammatory, pro-coagulant and pro-fibrogenic mediators that may play important roles in the pathophysiology of cardiac and arrhythmic complications. Collectively, these findings suggest that patients with NAFLD may benefit from more intensive surveillance and early treatment interventions to decrease the risk for CHD and other cardiac/arrhythmic complications. The purpose of this clinical review is to summarize the rapidly expanding body of evidence that supports a strong association between NAFLD and cardiovascular, cardiac and arrhythmic complications, to briefly examine the putative biological mechanisms underlying this association, and to discuss some of the current treatment options that may influence both NAFLD and its related cardiac and arrhythmic complications.

Keywords: Non-alcoholic fatty liver disease, Cardiovascular disease, Cardiac complications, Coronary heart disease, Myocardial dysfunction, Valvular heart disease, Arrhythmias, Arrhythmic complications

Core tip: The purpose of this clinical review is to summarize the rapidly expanding body of evidence that supports a strong association between non-alcoholic fatty liver disease (NAFLD) and cardiovascular, cardiac and arrhythmic complications, to briefly examine the putative biological mechanisms underlying this association, and to discuss some of the current treatment options that may influence both NAFLD and its related cardiac and arrhythmogenic complications.