Washington, USA: Researchers at the Smidt Heart Institute at Cedars-Sinai have found that even subtle forms of liver disease direct hit heart health.
The findings, recently published in the journal Frontiers in Cardiovascular Medicinehelp to further clarify the relationship between liver disease and heart disease beyond their shared risk factors.
In the retrospective study, the researchers compared the patients’ FIB-4 scores, a marker of liver fibrosis that may indicate the risk of developing severe liver disease, with cardiac abnormalities visible through cardiac MRIs. They found that elevated FIB-4 scores were associated with abnormalities in heart function and vascular dimension.
Alan Kwan, MD, a cardiologist and cardiac imaging researcher at the Smidt Heart Institute, as well as the study’s corresponding and senior author, said it was known that nonalcoholic fatty liver disease was associated with cardiovascular deathbut the relationship was not well understood and was possibly obscured by risk factors that both have in common, such as diabetes.
Previous similar studies had been limited in scope, looking only at how cirrhosis and nonalcoholic fatty liver disease affect the heart.
Earlier this year, the American Heart Association (AHA) issued a statement that nonalcoholic fatty liver disease, an increasingly common liver condition that affects more than one in four American adults, is a risk factor. for atherosclerotic cardiovascular disease.
And surprisingly, heart disease, not the progression of liver disease, is the leading cause of death in people with nonalcoholic fatty liver disease, according to the AHA.
“If 25% of the population has this potential risk factor for heart disease, we knew we needed to understand it further,” Kwan said. “So our overall goal with this study was to examine the connections between the heart and the liver, a newer area of study, but one that made sense to explore further. The liver processes cholesterol and produces factors involved in blood clotting. blood and inflammation — all of which can affect the heart — so we wanted to take a closer look at these associations.”
For the study, the researchers reviewed electronic medical records from the past 11 years of 1,668 patients who had low, moderate, or high FIB-4 scores within a year of cardiac MRI, adjusting for standard cardiovascular risk factors. They found that almost 86 percent of the patients had at least one heart abnormality.
Cardiac MRI provides a unique view of the heart, using detailed images that can identify subtle changes in the structure and function of the heart, the size and structure of the blood vessels, the composition of the heart muscle, and more.
“The abnormalities we saw were vascular changes: enlargement of the blood vessels leading out of the heart, as well as an increase in the amount of blood that was moving,” Kwan said.
“Usually when doctors look at the heart, we’re not thinking about the liver and vice versa. We tend to be very specialized in our own categories of organs. But the findings of this study indicate that we can and should look for liver conditions when looking at heart conditions: we can’t see the heart and liver as completely separate organs functioning on their own islands.”
The next step in the research, Kwan said, is to further explore the impact that liver disease can have on heart health.
“In addition, other questions arise,” he said, “like, when treating people with nonalcoholic fatty liver disease, could the drugs to treat this also help the heart? Or, when you see your cardiologist or primary care doctor and risk factors such as high cholesterol, blood pressure, diabetes, and family history, should nonalcoholic fatty liver disease also be a standard risk factor to consider?”
Susan Cheng, MD, MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute and the study’s lead and co-corresponding author, agreed that there are multiple reasons for continuing research in this area. .
“If we can understand the basic science of how the liver affects the heart, we can probably better understand other interactions between the heart and organs,” said Cheng, who also holds the Erika J. Glazer Chair in Women’s Cardiovascular Health and Heart Science. the population. “This could also shed light on potential future targeted therapies to prevent cardiovascular disease in patients with liver disease.”
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