Non-alcoholic fatty liver disease (NAFLD) is increasingly being recognized not just as a liver condition but as a major risk factor for cardiovascular events. A study presented at the 2017 AASLD Liver Meeting revealed that women with NAFLD face the same cardiovascular risk as men with the condition and a much higher risk than women without it.
A Loss of Cardiovascular Protection
Women typically have a lower cardiovascular risk than men. However, in the case of NAFLD, this protective effect appears to vanish.
- Study Findings:
- A 50-year-old woman with NAFLD had the same cardiovascular risk as:
- A 53-year-old man with NAFLD.
- A 58-year-old man without NAFLD.
- A 67-year-old woman without NAFLD.
- “In NAFLD, the protective effect of the female sex on cardiovascular risk disappears,” said Dr. Alina Allen of the Mayo Clinic.
- A 50-year-old woman with NAFLD had the same cardiovascular risk as:
What is NAFLD?
NAFLD, and its more severe form NASH (non-alcoholic steatohepatitis), is characterized by fat accumulation in the liver in people who do not drink heavily. It is:
- Linked to:
- Obesity and metabolic syndrome.
- Higher risks of liver inflammation, fibrosis, and cirrhosis.
- An increased likelihood of hepatocellular carcinoma (liver cancer).
- A global concern:
- Now the most common chronic liver disease worldwide.
Notably, people with NAFLD are more likely to die of cardiovascular disease than liver-related complications.
The Study at a Glance
Participants:
- Cohort Size: 3,869 individuals diagnosed with NAFLD in Minnesota (1997-2014).
- Controls: 15,209 matched individuals from the general population.
- Demographics:
- About half of the participants were women.
- Median age: 53 years.
- Individuals with NAFLD had higher rates of obesity, diabetes, and hypertension than their counterparts without NAFLD.
Methodology:
- Researchers tracked cardiovascular events such as:
- Chest pain (angina).
- Myocardial infarction (heart attack).
- Heart failure.
- Stroke.
- Atrial fibrillation (irregular heartbeat).
- Follow-up lasted up to 20 years.
Key Findings
Baseline Cardiovascular Risk:
- Both women and men with NAFLD had higher baseline rates of cardiovascular conditions than the general population.
- Men with NAFLD experienced more heart attacks and atrial fibrillation than women with NAFLD, but both groups were at higher risk than their counterparts without NAFLD.
Long-Term Cardiovascular Risk:
- In the general population:
- Women were significantly less likely than men to experience cardiovascular events.
- Among people with NAFLD:
- Incidence rates for women and men were comparable.
- Women with NAFLD faced cardiovascular risks similar to men with the condition.
Implications for Prevention
These findings suggest that cardiovascular risk assessments for individuals with NAFLD should take sex into account. Women with NAFLD may require more aggressive preventive strategies than previously thought, including:
- Lifestyle Interventions:
- Weight loss through diet and exercise.
- Reducing alcohol consumption.
- Medical Interventions:
- Aspirin or statins to manage cardiovascular risk factors.
- Regular monitoring of heart health.
A Call to Action
“Cardiovascular events started at an earlier age for these women than in the general population,” Dr. Allen emphasized. This underscores the need for earlier and more comprehensive cardiovascular care for women with NAFLD.
The study highlights a critical gap in how cardiovascular risk is managed in women with NAFLD. By recognizing that the protective effect of female sex does not extend to women with fatty liver disease, healthcare providers can take steps to address this silent but significant risk. Early interventions can not only improve cardiovascular outcomes but also enhance the overall quality of life for women living with NAFLD.