Risk of Heart Failure in Patients With Nonalcoholic Fatty Liver Disease: JACC Review Topic of the Week

J Am Coll Cardiol. 2022 Jan 18;79(2):180-191. doi: 10.1016/j.jacc.2021.11.007.


Heart failure (HF) and nonalcoholic fatty liver disease (NAFLD) are 2 conditions that have become important global public health problems. Emerging evidence supports a strong and independent association between NAFLD and the risk of new-onset HF, and there are multiple potential pathophysiological mechanisms by which NAFLD may increase risk of new-onset HF. The magnitude of this risk parallels the underlying severity of NAFLD, especially the level of liver fibrosis. Patients with NAFLD develop accelerated coronary atherosclerosis, myocardial alterations (mainly cardiac remodeling and hypertrophy), and certain arrhythmias (mainly atrial fibrillation), which may precede and promote the development of new-onset HF. This brief narrative review aims to provide an overview of the association between NAFLD and increased risk of new-onset HF, discuss the underlying mechanisms that link these 2 diseases, and summarize targeted pharmacological treatments for NAFLD that might also reduce the risk of HF.

Keywords: NAFLD; NASH; SGLT2-inhibitors; heart failure; nonalcoholic fatty liver disease; nonalcoholic steatohepatitis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Bariatric Surgery
  • Dysbiosis / complications
  • Glucagon-Like Peptide-1 Receptor / agonists
  • Heart Failure / etiology*
  • Heart Failure / prevention & control
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Life Style
  • Non-alcoholic Fatty Liver Disease / complications*
  • Non-alcoholic Fatty Liver Disease / therapy
  • Pioglitazone / therapeutic use
  • Risk Factors
  • Severity of Illness Index
  • Sodium-Glucose Transporter 2 Inhibitors / therapeutic use


  • Glucagon-Like Peptide-1 Receptor
  • Hypoglycemic Agents
  • Sodium-Glucose Transporter 2 Inhibitors
  • Pioglitazone