The association of non-alcoholic fatty liver disease and cardiac structure and function—Framingham Heart Study

Laura S. Chiu, Alison Pedley, Joseph M. Massaro, Emelia J. Benjamin, Gary F. Mitchell, David D. McManus, Jayashri Aragam, Ramachandran S. Vasan, Susan Cheng, Michelle T. Long

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background & Aims: Non-alcoholic fatty liver disease confers increased risk for cardiovascular disease, including heart failure (HF), for reasons that remain unclear. Possible pathways could involve an association of liver fat with cardiac structural or functional abnormalities even after accounting for body size. Methods: We analysed N = 2356 Framingham Heart Study participants (age 52 ± 12 years, 52% women) who underwent echocardiography and standardized computed tomography measures of liver fat. Results: In cross-sectional multivariable regression models adjusted for age, gender, cohort and cardiovascular risk factors, liver fat was positively associated with left ventricular (LV) mass (β = 1.45; 95% confidence interval (CI): 0.01, 2.88), LV wall thickness (β = 0.01; 95% CI: 0.00, 0.02), mass volume ratio (β = 0.02; 95% CI 0.01, 0.03), mitral peak velocity (E) (β = 0.83; 95% CI 0.31, 1.36) and LV filling pressure (E/e′ ratio) (β = 0.16; 95% CI 0.09, 0.23); and inversely associated with global systolic longitudinal strain (β = 0.20, 95% CI 0.07, 0.33), diastolic annular velocity (e′) (β = −0.12; 95% CI − 0.22, −0.03), and E/A ratio (β = −0.01; 95% CI − 0.02, −0.00). After additional adjustment for body mass index (BMI), statistical significance was attenuated for all associations except for that of greater liver fat with increased LV filling pressure, a possible precursor to HF (β = 0.11; 95% CI 0.03, 0.18). Conclusion: Increased liver fat was associated with multiple subclinical cardiac dysfunction measures, with most of associations mediated by obesity. Interestingly, the association of liver fat and LV filling pressure was only partially mediated by BMI, suggesting a possible direct effect of liver fat on LV filling pressure. Further confirmatory studies are needed.

Original languageEnglish (US)
Pages (from-to)2445-2454
Number of pages10
JournalLiver International
Issue number10
StatePublished - Oct 1 2020
Externally publishedYes


  • heart failure
  • non-alcoholic fatty liver disease
  • subclinical cardiovascular disease

ASJC Scopus subject areas

  • Hepatology


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