Fatty Liver Disease and Heart Disease
Fatty liver disease (also called steatotic liver disease) happens when too much fat builds up in your liver. It can be caused by high alcohol use or metabolic syndrome (a group of conditions like obesity, high cholesterol, or high blood pressure).
But don’t be fooled by the name. Fatty liver disease isn’t just a liver problem — it affects your whole body. Perhaps most importantly, it has major impacts on the heart.
Can fatty liver disease cause heart problems?
Fatty liver disease — both alcohol-related and non-alcohol-related — is linked to heart disease. In fact, heart disease is the most common cause of death among people who have metabolic dysfunction-associated steatotic liver disease (MASLD) (previously known as non-alcoholic liver disease).
Fatty Liver Disease and Heart Disease Symptoms
Fatty liver disease might cause some symptoms or none at all. Some common ones are:
- Stomach pain
- Heaviness in your upper right abdomen
- Weakness
- Fatigue
If fatty liver disease leads to a liver disease called cirrhosis, you might notice symptoms like yellowing of the skin and whites of the eyes, unexplained weight loss, and swelling in the abdomen, hands, legs, and feet.
Heart disease has a different, larger set of symptoms, including:
- Fast or pounding heartbeat
- Sweating
- Lightheadedness or dizziness
- Trouble breathing
- Chest or neck pain
- Pressure or discomfort in chest
- Acid reflux
- Nausea or vomiting
- Swelling in your lower body
- Fatigue
- Difficulty exercising
- Trouble sleeping
- Fever
Heart disease is a common complication of fatty liver. It’s also the most common cause of death among people with MASLD. If you have fatty liver disease, it’s important to look out for signs of heart disease as well. That way, you can catch and treat any problems sooner rather than later.
It’s not clear why fatty liver disease and heart disease are so closely linked. But several things might play a role.
Chronic inflammation. Like other metabolic disorders, fatty liver disease could cause chronic (constant) inflammation, which could then lead to heart disease. This is because the liver might create chemical signals that make the body think it is being attacked by germs. In response to the signals, the body uses inflammation to attack the nonexistent germs, but accidentally harms itself in the process. Inflammation can be particularly dangerous for the cardiovascular system because it causes changes in blood vessels.
Oxidative stress. This is a chemical imbalance that happens when the body releases too many inflammatory chemicals. It is closely related to inflammation.
Insulin resistance. This is when cells don’t respond appropriately to a hormone called insulin. Insulin resistance is a major risk factor for MASLD, metabolic syndrome, and atherosclerosis (hardening of the arteries).
High cholesterol. The liver is in charge of monitoring your body’s levels of cholesterol and other fats. Because of this, fatty liver disease can affect your cholesterol levels. High cholesterol is also linked to heart disease.
Adipokines. These are hormones made by fat. They travel through the bloodstream, where they affect the blood vessel walls. Some have anti-inflammatory effects, but others can raise inflammation and contribute to heart disease.
Gut microbiota. Fatty liver disease, along with diabetes and obesity, can alter the communities of microbes living in your gut. Some microbial imbalances can lead to inflammation and raise your risk for liver fibrosis and heart disease.
Genetics. Some genes may also play a role in the development of fatty liver and heart disease. If you already have fatty liver, certain genetic variations can affect how severe your liver disease is and the likelihood of it leading to heart problems.
Belly fat. If you have a fatty liver, you may have extra belly fat as well. This can raise your risk for metabolic syndrome and heart disease.
Fatty Liver Disease and Heart Disease Risk Factors
Having fatty liver disease can raise your risk of developing other diseases, especially heart disease. Scientists have shown that this is true even after you adjust for other risk factors, including metabolic syndrome conditions. This means that fatty liver disease is a risk factor for heart disease in and of itself.
Some cardiovascular effects of fatty liver disease include:
- Coronary artery disease
- Carotid disease
- Structural alterations
- Increased epicardial fat (fat around the heart)
- Valvular calcifications
- Functional alterations
- Arrhythmias
- Conduction alterations
- Lengthened QTc interval
Fatty liver and heart disease are also associated with metabolic syndrome, a group of linked conditions.
Metabolic syndrome
Metabolic syndrome has five features:
- Obesity
- Dyslipidemia
- Hypertension
- Insulin resistance
- Poor glucose tolerance
About 9 in 10 of people with MASLD have at least one feature of metabolic syndrome, and 1 in 3 can be officially diagnosed with metabolic syndrome (this means they have at least three features of metabolic syndrome).
According to some doctors, MASLD happens when metabolic syndrome affects the liver.
Type 2 diabetes
The liver has many jobs. One is to regulate blood sugar levels. It does this by absorbing glucose whenever it receives insulin, a hormonal signal from the pancreas. But in fatty liver disease, the liver cells don’t respond to insulin as well as they should. As a result, the pancreas pumps out more and more insulin. This is called insulin resistance, and it can lead to type 2 diabetes. Because of this, MASLD and diabetes are closely linked. Type 2 diabetes also can make liver disease worse.
Dyslipidemia
Another job of the liver is to regulate cholesterol and other fats. However, extra fat in the liver can disrupt this process, causing levels of low-density lipoprotein (LDL, or “bad”) cholesterol to rise. As a result, MASLD is associated with dyslipidemia.
Hypertension
MASLD also is linked to hypertension, which is another feature of metabolic syndrome. MASLD can cause inflammation and insulin resistance, both of which raise blood pressure. In particular, insulin resistance can lead to water retention and constricted blood vessels.
Heart Problems and Conditions Related to Fatty Liver Disease
Fatty liver disease can affect the heart in many ways.
Atherosclerosis
This is when plaques form in your blood vessels, causing their walls to narrow and harden. It’s linked to inflammation, which can lower the wall’s elasticity and alter the life cycle of the cells there. Insulin resistance, adipose tissue dysfunction, the gut microbiota, and genetic factors might also play a role in the development of atherosclerosis in people with MASLD.
Coronary artery disease
When atherosclerosis affects the coronary arteries (the blood vessels that supply blood to the heart), it is called coronary artery disease. It seems to be associated with insulin resistance and the amount of fat in the liver. Fatty liver disease can also cause calcification (the formation of calcium plaques) in the aortic and mitral valves of the heart, which can raise your risk for arrhythmias.
Microvascular dysfunction
MASLD also is associated with coronary microvascular dysfunction. This is a type of coronary artery disease that involves the tiniest blood vessels. With this condition, blood can pass through the major coronary artery just fine, but struggles to flow through the tiny blood vessels that branch out into the rest of the body. This causes chest pain.
Arrhythmias
Fatty liver disease can lead to abnormal heart rhythms, including atrial fibrillation and ventricular arrhythmias. The risk is especially high for people with MASLD who also have type 2 diabetes.
Heart attack risk
Among people who have heart attacks, people with MASLD are more likely to die than those who don’t have it. This might have to do with poor circulation, inflammatory endothelial disruption, oxidative stress, and factors that might make patients more likely to have a heart attack.
Ventricular hypertrophy
Fatty liver disease can alter the shape and function of the heart, including a part called the left ventricle. The left ventricle is involved with pumping blood. Fatty liver disease can cause the left ventricle to gain mass (become heavier) and its walls to become thicker.
Cardiomyopathy
This is another name for any problem that affects the heart muscle. It’s linked to heavy alcohol use, high blood pressure, and coronary artery disease. Many people with cirrhosis, a form of liver disease, experience a condition called cirrhotic cardiomyopathy.
Hepatopulmonary syndrome
About 1 in 4 people with chronic liver disease will develop hepatopulmonary syndrome. This is when liver disease causes the blood vessels in the lungs to widen, lowering their ability to move oxygen from the lungs to the rest of the body. This leads to low blood oxygen levels.
Fatty liver and heart failure
Enlargement of the left ventricle, microvascular dysfunction, coronary artery disease, atrial defibrillation, and autonomic dysfunction all may contribute to heart failure in people with MASLD.
How to Prevent Heart Disease With Fatty Liver Disease
If you have fatty liver disease, that doesn’t automatically mean you will have heart problems. You can lower your risk with some simple lifestyle changes.
Diet, exercise, and weight management
Doctors are still figuring out the best diet recommendations for people with fatty liver disease. Some promising options are:
- Following a low-calorie diet (1,200-1,600 calories per day)
- Avoiding sugar
- Eating a low-fat diet (less than <10% saturated fats) with plenty of fruits and vegetables
- Following the Mediterranean diet, which is high in healthy fats
- Drinking coffee regularly
Eating plenty of omega-3 fatty acids (like those in olive oil) may help with cholesterol levels in people with MASLD. In addition, some doctors think that antioxidants and vitamin E might help with fatty liver and heart disease, but more research is needed to be sure.
Exercise also can help with fatty liver disease. In particular, it can lower insulin resistance, which is tied to many of the heart problems associated with fatty liver disease. Try working on your moderate-intensity aerobic exercises (brisk walking, swimming, etc.) for at least 135 minutes per week.
Some research suggests that losing 5%-10% of your body weight can help with fatty liver disease and prevent it from getting worse. It may even be able to reverse damage to the heart muscle. This is true regardless of how you lose weight (diet, exercise, etc.). If changes in diet and exercise don’t work, weight loss surgery may be a good option. Keep in mind that losing weight can be risky for people who already have fatty liver and advanced heart problems.
Talk with your doctor before making any changes to your diet or exercise routine. They can help you choose a plan that is right for you.
Managing blood pressure and cholesterol
Controlling cholesterol levels is important for protecting your heart health. Medications called statins can help manage your cholesterol. Some studies have suggested that statins may also help with liver disease, so they are strongly recommended for people with high cholesterol and MASLD. Meanwhile, if you have high blood pressure and fatty liver, taking antihypertensive medications (like ACE inhibitors) can help prevent the fatty liver from getting worse.
Doctors also are researching medications called insulin sensitizers. The idea is that these medications could help with insulin resistance, which is linked to fatty liver and heart problems. For example, a medication called pioglitazone could lower insulin resistance and inflammation in people with MASLD. Similar medications called glucagon-like peptide-1 receptor agonists (exenatide, liraglutide, lixisenatide, and semaglutide) may also help lower your appetite, helping you to lose weight. But more research is needed to be sure.
Smoking and drinking
To protect your liver from further damage, doctors recommend cutting back or quitting smoking and drinking. Both smoking and heavy drinking can raise your blood pressure and cholesterol levels, two important components of heart health. Smoking in particular is associated with nearly all types of heart disease.
Takeaways
Fatty liver disease is closely linked with heart disease. It can lead to plaque formation in the arteries, especially the coronary arteries, as well as arrhythmias and changes in the left ventricle of the heart. If you have fatty liver disease, talk with your doctor about how to best protect your heart health.
Fatty Liver and Heart Disease FAQs
What does fatty liver disease have to do with your heart?
Fatty liver disease is closely linked to heart disease, especially conditions like atherosclerosis, coronary artery disease, and arrhythmias.
Can fatty liver disease cause an irregular heartbeat?
Yes, fatty liver disease can lead to irregular heart rhythms (arrhythmias).
Can fatty liver cause AFib?
AFib is one of the most common arrhythmias linked to fatty liver disease.
What foods should I avoid with fatty liver and heart disease?
Doctors are still figuring out what the best diet is for people with fatty liver and heart disease. In general, a diet low in fat, calories, and sugar that contains plenty of fruits and vegetables may be a good way to go.
