Towards a broader perspective on non-alcoholic fatty liver disease and coronary artery disease relationship: managing metabolic risk beyond genetics

This editorial refers to ‘The association between non-alcoholic liver fatty disease and coronary artery calcification: a two-sample Mendelian randomization study’, by L. He et al. https://doi.org/10.1093/eurjpc/zwae336. The interplay between non-alcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) has long been described. Evidence suggests that NAFLD is associated with an increased risk of developing a wide range of cardiovascular diseases, including atherosclerosis,1 myocardial infarction, and stroke,2 and several meta-analyses have also repeatedly confirmed these associations.3–5 Recently, metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a new nomenclature for the presence of fatty liver disease,6,7 shifting the focus to the presence and prominent role of metabolic risk factors, replacing the somewhat old concept of NAFLD. This has implied a comprehensive inclusion of all patients with liver steatosis and at least another metabolic risk factor. Indeed, unlike the restrictive criteria for NAFLD,8 MASLD eliminates the need for a liver biopsy for a definite diagnosis and allows the inclusion of patients with alcohol consumption. Such a broader definition helps to identify patients at higher risk of atherosclerotic events even at an early stage of liver disease.