Nonalcoholic fatty liver disease and cardiovascular risk. Literature review

Abstract

The article presents research data on the association of nonalcoholic fatty liver disease (NAFLD) with cardiovascular diseases, which determine the main severity of the prognosis in this patients’ population. This indicates that NAFLD should be considered as a significant risk factor for fatal and nonfatal cardiovascular events due to its close relationship with the development of atherosclerosis and the severity of coronary heart disease. It is emphasized that such factors of NAFLD as insulin resistance and dyslipidemia, which has a pronounced atherogenic nature, the development of pro-oxidant stress, imbalance of adipokines and cytokines can contribute to widespread atherosclerotic lesions of blood vessels and heart up to the development of acute coronary syndrome. In this aspect, the article draws attention to the ability of NAFLD to potentiate the development of hypercoagulable conditions with subsequent thrombus formation, which will further contribute to the development of acute conditions. In addition, the article separately provides data on the participation of the intestinal microbiota, which has characteristic changes in patients with NAFLD, in potentiating the development of cardiovascular diseases. The results of studies on the influence of endotoxin on the development of inflammatory processes, endothelial dysfunction, arrhythmias, myocardial dysfunction and hypercoagulable states are described. It is also emphasized that many researchers have presented convincing data to support the association of NAFLD with subclinical atherosclerosis and that this association is primarily mediated by liver fibrosis, as well as cardiovascular risk in clinical atherosclerosis. In addition, data on the severity of the course of coronary heart disease in comorbidity with NAFLD are given. It is noted that in order to prevent the progression of cardiovascular diseases in patients with NAFLD, early monitoring of cardiovascular risk and priority treatment of NAFLD in the early stages, before the development of fibrosis or in order to stop its progression, is very important, which can effectively reduce further cardiovascular risk, and this is especially relevant in patients with subclinical atherosclerosis. The authors believe that further research in this direction is very relevant and a priority, as it will contribute to the development of effective approaches to the treatment and elimination of cardiovascular risk factors in patients with NAFLD.