Cardiovascular Risk in Women with Fatty Liver Disease: Risk is Not Equal Opportunity

Nonalcoholic fatty liver disease is associated with significantly higher risk of subsequent cardiovascular events in women, but not in men, according to research presented this week at The Liver Meeting® — held by the American Association for the Study of Liver Diseases.

Nonalcoholic fatty liver disease, commonly called NAFLD, is a group of diseases characterized by an excessive accumulation of fat in the liver, and most often occurring in people who consume little to no alcohol. NAFLD is the most common form of chronic liver disease in children and adults, affecting 80 to 100 million people around the world.

NAFLD has been recognized as a risk factor for cardiovascular incidents – such as heart pain, heart attack, heart failure, irregular and rapid heartbeat and stroke. Cardiovascular disease is generally known to occur less in women, simply because of their female sex. This made researchers at Mayo Clinic in Rochester, Minn. interested in exploring if sex‐related differences in cardiovascular events persist in patients with NAFLD.

Alina M. Allen, MD, assistant professor of Medicine at the Mayo Clinic's Division of Gastroenterology and Hepatology, and her team compared 3,869 people who were diagnosed with NAFLD between 1997 and 2014 to 15,209 people without the disease (all of which lived in the same community and were matched based on age, gender and pre‐existing cardiovascular diseases).

"We followed this cohort for up to 20 years and examined the number of new cardiovascular events that occurred in men and women after NAFLD diagnosis and their matched counterparts," explains Dr. Allen. "We noted that in subjects with NAFLD, the risk for these events was higher in women than in men, but contrary to those without the liver disease. In NAFLD, the protective effect of the female sex on cardiovascular risk disappears. Additionally, we noted cardiovascular events started at an earlier age for these women than in the general population."

These findings suggest that cardiovascular risk assessment in NAFLD should consider sex‐related differences, as women may require more aggressive preventative measures to avoid worse cardiovascular outcomes.

Future studies should assess preventative measures that could lower this risk.