Fatty liver disease raises heart risk, and for most people who have it the heart is the bigger concern. Cardiovascular disease, not liver failure, is the leading cause of death in people with fatty liver.
That surprises many people who were told about fat on a liver scan and assumed it was only a liver problem. Fatty liver and artery disease grow from the same roots, so finding one is a good reason to check for the other.
Key takeaways
- People with fatty liver die of heart and blood vessel disease more often than of liver disease.
- Pooled studies put the added risk of a cardiovascular event at roughly 45%, and higher when the liver is scarred.
- The condition is common and usually causes no symptoms.
- It has a new name, MASLD, that puts its metabolic causes front and center.
What fatty liver is, and why the name changed
Fatty liver means extra fat stored inside liver cells. For decades the common form was called nonalcoholic fatty liver disease, or NAFLD, to separate it from liver damage caused by heavy drinking.
In 2023 an international group of liver societies replaced that name with metabolic dysfunction-associated steatotic liver disease, or MASLD. The new definition requires fat in the liver plus at least one of five cardiometabolic risk factors.1 The panel also created a separate category, MetALD, for people who have metabolic fatty liver and also drink larger amounts of alcohol.
You will see both names. Older reports and many studies say NAFLD. Newer ones say MASLD. They refer to the same basic condition, with the newer name adding the metabolic requirement. The change makes the heart connection plain: this is a metabolic condition that shows up in the liver.
How common it is
Very common. A systematic review covering more than 9 million people estimated that about 30% of adults worldwide have it, and found that the share has been rising.2 An American Gastroenterological Association pathway puts the figure for US adults at about 37%.3
Most people do not know. An American Heart Association scientific statement describes the condition as typically silent until advanced liver damage occurs, and says the majority of people who have it are unaware of it.
The heart is the main risk
Fatty liver can progress to inflammation, scarring, cirrhosis and liver cancer, and those outcomes are serious. They are not what most people with fatty liver die of. The heart association statement calls atherosclerotic cardiovascular disease the principal cause of death in patients with the condition.4
The global review gives a sense of scale. Among people diagnosed without a liver biopsy, the pooled death rate from cardiac causes was 4.20 per 1,000 people per year, compared with 0.92 per 1,000 for liver-specific causes.2
How much higher is the risk?
The largest pooled analysis combined 36 long-term studies with about 5.8 million middle-aged adults, followed for a median of 6.5 years. Fatty liver was associated with about a 45% higher risk of fatal or non-fatal cardiovascular events.
The risk rose with the severity of liver disease, and scarring mattered most. In studies that looked at more advanced disease, particularly a higher fibrosis stage, the risk was about two and a half times as high.5 Fibrosis is the medical word for scar tissue in the liver.
These links held after accounting for age, sex, body fat, diabetes and other common risk factors. Even so, the studies were observational. The authors wrote that fatty liver might be an independent risk factor, which is careful wording. It is not yet clear how much the liver itself adds to artery disease and how much it simply marks the conditions that cause both.
Why the two travel together
Fatty liver rarely appears alone. A US endocrinology guideline describes it as closely linked to obesity and type 2 diabetes, and the 2023 definition builds cardiometabolic risk factors into the diagnosis itself.
A common thread is insulin resistance, which our separate page explains. A closely related topic has its own guide: visceral fat and heart risk.
What gets checked
A fatty liver finding usually leads to two parallel sets of questions.
| Question | What clinicians look at |
|---|---|
| How is the liver itself? | The degree of scarring, since care depends on accurate staging of fibrosis risk |
| What is driving it? | Weight and waist size, blood sugar and A1c, alcohol intake |
| What is the heart risk? | Blood pressure, a cholesterol panel, diabetes status, family history, an overall risk estimate |
The liver side belongs with your primary care doctor or a liver specialist. The heart side is ordinary risk assessment, done with the knowledge that fatty liver is associated with higher cardiovascular risk. The endocrinology guideline says management should promote cardiometabolic health and reduce the increased cardiovascular risk that comes with the disease.6
Treatment choices are beyond the scope of this article and belong with your clinician.
Your next step
If you have been told you have fatty liver, ask where your heart risk stands as well. Our guide to the ApoB test explains a blood test that counts the particles carrying cholesterol, and our guide to the PREVENT risk calculator explains how an overall estimate is built.
You can also answer the three quick questions in the screener on the Cardio Res-Q program page.
Are You a Candidate for Cardio Res-Q?
Three quick questions about the risk factors we screen for. Your answers stay between you and the clinic.
Frequently asked questions
I was told I have NAFLD. Is MASLD something different?
For most people it is the same condition under a new name. A 2023 international consensus replaced NAFLD with MASLD and added the requirement of at least one cardiometabolic risk factor alongside fat in the liver.
Does fatty liver cause symptoms?
Usually not. The American Heart Association describes it as typically silent until advanced liver damage occurs, which is why most people who have it do not know.
Does everyone with fatty liver have high heart risk?
No. On average the added risk is moderate, and it rises with the severity of liver disease, particularly scarring. Your own risk depends on the rest of your picture: blood pressure, cholesterol, blood sugar, smoking and family history.
Is fatty liver only a problem for people who drink?
No. MASLD is defined by metabolic risk factors, not alcohol. People who have metabolic fatty liver and also drink above set weekly amounts fall into a separate category called MetALD.
Related reading
This article is for general education and is not medical advice. Decisions about testing and medication should be made with your clinician. If you have chest pain or other symptoms of a heart attack, call 911.
