title: Nonalcoholic fatty liver disease and vascular disease: state-of-the-art.
abstract: Nonalcoholic fatty liver disease (NAFLD), the most common of chronic liver disease in Western Country, is closely related to insulin resistance and oxidative stress and includes a wide spectrum of liver diseases ranging from steatosis alone, usually a benign and non-progressive condition, to nonalcoholic steatohepatitis (NASH), which may progress to liver fibrosis and cirrhosis. NAFLD is considered the hepatic manifestation of the metabolic syndrome with which shares several characteristics, however recent data suggest that NAFLD is linked to increased cardiovascular risk independently of the broad spectrum of risk factors of metabolic syndrome. Accumulating evidence suggests that the clinical burden of NAFLD is not restricted to liver-related morbidity and mortality, with the majority of deaths in NAFLD patients related to cardiovascular disease and cancer and not to the progression of liver disease. Retrospective and prospective studies provide evidence of a strong association between NAFLD and subclinical manifestation of atherosclerosis (increased intima-media thickness, endothelial dysfunction, arterial stiffness, impaired left ventricular function and coronary calcification). A general agreement emerging from these studies indicates that patients with NASH are at higher risk of cardiovascular diseases than those with simple steatosis, emphasizing the role of chronic inflammation in the pathogenesis of atherosclerosis of these patients. It is very likely that the different mechanisms involved in the pathogenesis of atherosclerosis in patients with NAFLD have a different relevance in the patients according to individual genetic background. In conclusion, in the presence of NAFLD patients should undergo a complete cardiovascular evaluation to prevent future atherosclerotic complications. Specific life-style modification and aggressive pharmaceutical modification will not only reduce the progression of liver disease, but also reduce morbidity for cardiovascular disease improving overall prognosis and survival.
authors.affiliation: Silvia Fargion, Marianna Porzio, Anna Ludovica Fracanzani, Department of Pathophysiology and Transplantation, Metabolic Liver Diseases Research Center, Ca' Granda IRCCS Foundation, Policlinico Hospital Pad Granelli, 20122 Milano, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Fargion
authors.affiliation: Silvia Fargion, Marianna Porzio, Anna Ludovica Fracanzani, Department of Pathophysiology and Transplantation, Metabolic Liver Diseases Research Center, Ca' Granda IRCCS Foundation, Policlinico Hospital Pad Granelli, 20122 Milano, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Porzio
authors.affiliation: Silvia Fargion, Marianna Porzio, Anna Ludovica Fracanzani, Department of Pathophysiology and Transplantation, Metabolic Liver Diseases Research Center, Ca' Granda IRCCS Foundation, Policlinico Hospital Pad Granelli, 20122 Milano, Italy.
authors.forename: Anna Ludovica
authors.initials: AL
authors.lastname: Fracanzani
mesh_terms: D059168:Carotid Intima-Media Thickness; D002423:Cause of Death; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D050356:Lipid Metabolism; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D018384:Oxidative Stress; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D014652:Vascular Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D059289:Vascular Stiffness; D016277:Ventricular Function, Left
chemical_list: D018836:Inflammation Mediators
keywords: Cardiovascular risk; Early atherosclerosis; Epicardic fat; Inflammation; Intima-media thickness; Non-alcoholic steatohepatitis; Nonalcoholic fatty liver disease; Steatosis