IMR Press / RCM / Volume 22 / Issue 3 / DOI: 10.31083/j.rcm2203082
Open Access Review
Pathophysiological mechanisms and clinical evidence of relationship between Nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease
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1 Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
2 Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
3 Division of Cardiology, A.O.R.N. “Sant’Anna & San Sebastiano”, I-81100 Caserta, Italy
4 Department of Precision Medicine, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy
*Correspondence: (Ferdinando Carlo Sasso)
These authors contributed equally.
Academic Editor: Peter A. McCullough
Rev. Cardiovasc. Med. 2021, 22(3), 755–768;
Submitted: 6 August 2021 | Revised: 6 September 2021 | Accepted: 9 September 2021 | Published: 24 September 2021
(This article belongs to the Special Issue Featured Papers in Cardiovascular Medicine 2021)
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (

Evidence suggests a close connection between Nonalcoholic Fatty Liver Disease (NAFLD) and increased cardiovascular (CV) risk. Several cross-sectional studies report that NAFLD is related to preclinical atherosclerotic damage, and to coronary, cerebral and peripheral vascular events. Similar results have been showed by prospective studies and also by meta-analyzes on observational studies. The pathophysiological mechanisms of NAFLD are related to insulin resistance, which causes a dysfunction in adipokine production, especially adiponectin, from adipose tissue. A proinflammatory state and an increase in oxidative stress, due to increased reacting oxygen species (ROS) formation with consequent oxidation of free fatty acids and increased de novo lipogenesis with accumulation of triglycerides, are observed. These mechanisms may have an impact on atherosclerotic plaque formation and progression, and they can lead to increased cardiovascular risk in subjects with NAFLD. This review extensively discusses and comments current and developing NAFLD therapies and their possible impact on cardiovascular outcome.

Cardiovascular disease
Type 2 diabetes
Cardiovascular risk
Fig. 1.
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