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World J Meta-Anal. Apr 28, 2021; 9(2): 164-175
Published online Apr 28, 2021. doi: 10.13105/wjma.v9.i2.164
Nonalcoholic fatty liver disease and cardiovascular concerns: The time for hepatologist and cardiologist close collaboration
Haleh Ashraf, Shahrokh Karbalai, Raika Jamali
Haleh Ashraf, Shahrokh Karbalai, Raika Jamali, Research Development Center, Tehran University of Medical Sciences, Tehran 1938934131, Iran
Author contributions: Ashraf H and Jamali R proposed the idea; Ashraf H, Karbalai S and Jamali R searched the database and extracted the articles; Ashraf H and Jamali R wrote the manuscript; All the authors read and approved the final draft.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raika Jamali, MD, Associate Professor, Research Development Center, Tehran University of Medical Sciences, Imam Khomeini St. Hassan Abad Sq., Sina Hospital, Tehran 1938934131, Iran. jamalira@tums.ac.ir
Received: January 29, 2021
Peer-review started: January 29, 2021
First decision: March 14, 2021
Revised: March 17, 2021
Accepted: April 23, 2021
Article in press: April 23, 2021
Published online: April 28, 2021
Processing time: 88 Days and 15.9 Hours
Abstract

Nonalcoholic fatty liver disease (NAFLD) has emerged as the most common chronic liver cell damage worldwide. It is strongly associated with an increased risk of cardiovascular disease (CVD). There are not enough recommendations for screening subjects with nonalcoholic steatohepatitis cirrhosis, who are not candidates for liver transplantation, nor who are asymptomatic with NAFLD without cirrhosis. In the current comprehensive narrative review, we aimed to evaluate the associations between CVD and NAFLD. Distinguishing the mechanisms linking these two disorders offers the opportunity to develop targeted therapies. Moreover, we will discuss screening approaches (whom and how-to) and treatment modalities proposed to reduce cardiovascular risk in patients with NAFLD.

Keywords: Nonalcoholic steatohepatitis; Cardiovascular disease; Screening; Atherosclerosis; Risk scores; Metabolic syndrome

Core Tip: The diagnosis of nonalcoholic fatty liver disease (NAFLD) deserves a thoughtful cardiovascular risk assessment and evaluation for subclinical atherosclerosis to prevent cardiovascular disease (CVD) morbidity/mortality. In patients with nonalcoholic steatohepatitis-related cirrhosis undergoing liver transplantation, screening for significant CAD should be done by stress echocardiography and computed tomography coronary angiography. Recommendation for screening in asymptomatic NAFLD without significant fibrosis is not clear. The basis of NAFLD prevention and treatment is lifestyle modifications, while concomitant cardiovascular risk factors should be targeted.