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Increased risk of cardiovascular disease and chronic kidney disease in NAFLD

Nature Reviews Gastroenterology & Hepatology volume 9, pages 372–381 (2012)Cite this article

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Abstract

NAFLD is very common in the general population and its prevalence is increasing worldwide in parallel with the increasing incidences of obesity and metabolic diseases, mainly type 2 diabetes. In some cases, however, the diagnosis of NAFLD remains uncertain because other causes of liver disease are not easy to exclude in patients who are diagnosed with NAFLD after a biochemical or ultrasonographic analysis. Several studies have documented a strong association between NAFLD and traditional and nontraditional risk factors for cardiovascular disease (CVD) and chronic kidney disease (CKD). Accordingly, patients with NAFLD have an increased prevalence and incidence of both CVD and CKD. It is reasonable to believe that NAFLD, CVD and CKD share common risk factors (such as visceral obesity, insulin resistance, dysglycaemia, dyslipidaemia and hypertension) and therefore that NAFLD might simply be a marker rather than a causal risk factor of CVD and CKD. In this context, the identification of NAFLD might be an additional clinical feature to improve the stratification of patients for their risk of CVD and CKD. Growing evidence suggests that in patients with NAFLD, especially if NASH is present, several molecules released from the steatotic and inflamed liver might have pathogenic roles in the development of atherosclerosis and kidney damage. If these findings are confirmed by further studies, NAFLD could become a target for the prevention and treatment of CVD and CKD. NAFLD, whatever its role (marker or causal risk factor), is therefore a clinical condition that deserves greater attention from gastroenterologists, endocrinologists, cardiologists and nephrologists, as well as internists and general practitioners.

Key Points

  • NAFLD is very frequent in the general population and its prevalence is increasing in parallel with the increases in the incidences of obesity and metabolic diseases

  • Risk factors for cardiovascular disease (CVD) and chronic kidney disease (CKD) are common in patients with NAFLD, who are more likely to have these diseases than the general population

  • Visceral obesity, insulin resistance and the metabolic syndrome are certainly common to NAFLD, CVD and CKD, but NAFLD might be a pathogenic factor of both CVD and CKD

  • Various molecules released by the steatotic and inflamed liver might contribute to the development and progression of both CVD and CKD

  • Clinicians who manage patients with NAFLD (particularly NASH) should be aware of the increased risk of CVD and CKD, and should target individual risk factors and underlying disorders

  • Targeting NAFLD with specific tools, when available, might also result in a reduction of the risk of both CVD and CKD

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Figure 1: The metabolic syndrome is a constellation of inter-related metabolic abnormalities that includes glucose intolerance, insulin resistance, visceral obesity, atherogenic dyslipidaemia, thrombophilia, hyperuricaemia and hypertension, all risk factors for CVD and CKD.
Figure 2: NAFLD, CVD and CKD: an intriguing pathophysiological network.
Figure 3: Potential molecules and factors linking NAFLD to the development and progression of atherosclerosis and kidney disease.

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The authors contributed equally to the research of literature data and the writing of the article, provided substantial contributions to the discussion of contents, and reviewed/edited the manuscript before submission.

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Correspondence to Enzo Bonora.

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Bonora, E., Targher, G. Increased risk of cardiovascular disease and chronic kidney disease in NAFLD. Nat Rev Gastroenterol Hepatol 9, 372–381 (2012). https://doi.org/10.1038/nrgastro.2012.79

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