Fatty Liver Disease May Raise Heart Attack Risk By Nearly 70%

ApoB, high cholesterol, insulin resistance, elevated triglycerides, high blood pressure—these are the risk factors that usually dominate conversations around cardiovascular health. Liver disease typically isn’t part of that discussion. But a new study published in Clinical Gastroenterology and Hepatology suggests it probably should be.

The study analyzed data from more than 3,600 adults participating in the PROMISE trial, a large multicenter study focused on patients being evaluated for chest pain. Researchers used cardiac CT scans to examine both the heart and portions of the liver visible on imaging.

About one in four participants had hepatic steatosis, the medical term for fatty liver disease.

Then researchers looked more closely at plaque composition inside the coronary arteries. This distinction is important because not all plaque behaves the same way. Calcified plaque is generally more stable. Noncalcified plaque is softer, more inflamed, and more likely to rupture suddenly and trigger a heart attack.

People with fatty liver disease had substantially higher amounts of this noncalcified plaque.

Specifically, researchers found a 24% increase in noncalcified plaque volume and a significantly greater burden of overall high-risk plaque compared to participants without fatty liver disease. Over the following two years, those individuals also experienced markedly higher rates of major cardiovascular events, including heart attack, unstable angina, and death.

Even after adjusting for traditional cardiovascular risk factors like obesity, blood pressure, and diabetes, fatty liver disease still remained associated with a 69% higher risk of major cardiac events.

Chronic liver disease is the 11th leading cause of death worldwide. Additionally, cases of metabolic dysfunction–associated steatotic liver disease (MASLD), previously referred to as non-alcoholic fatty liver disease, have surged by 143%1 since 1990, reaching an estimated 1.3 billion people in 2023. 

And unlike some diseases, fatty liver doesn’t announce itself early with obvious symptoms, which is why it is often referred to as “silent.” 

The condition often develops gradually alongside insulin resistance, elevated triglycerides, visceral fat accumulation, poor sleep, low physical activity, excess ultra-processed food intake, and metabolic dysfunction.

Meanwhile, the same metabolic processes affecting the liver also tend to affect blood vessels. Chronic inflammation, impaired blood sugar regulation, oxidative stress, and abnormal lipid metabolism create conditions that make artery walls more vulnerable over time.

Researchers in this study suggest that fatty liver disease may be part of a broader “liver-heart axis,” where metabolic dysfunction in one organ reflects increased stress throughout the cardiovascular system.

Fatty liver disease is often highly responsive to lifestyle changes, especially earlier in the process.

A big focus is to reduce visceral fat, the deeper abdominal fat that’s strongly tied to insulin resistance and liver fat buildup. And despite what a lot of people assume, that doesn’t necessarily mean chasing dramatic weight loss. Resistance training can make a major difference here because building muscle improves how the body handles blood sugar and fats overall.

Increasing overall movement is important, as well. Long sedentary stretches worsen insulin resistance, while regular walking, post-meal movement, and aerobic exercise help lower liver fat and triglycerides over time.