{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:21:37Z","timestamp":1792095697127,"version":"4.4.0"},"reference-count":91,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,23]],"date-time":"2025-02-23T00:00:00Z","timestamp":1740268800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Metabolites"],"abstract":"<jats:p>Background: Non-alcoholic fatty liver disease (NAFLD), more recently redefined as metabolic-associated fatty liver disease (MAFLD), is now recognized as the most prevalent cause of chronic liver disease. Its strong association with cardiovascular disease (CVD) underscores its emerging role in global morbidity and mortality. Objective: This review critically examines the pathophysiological mechanisms that link NAFLD\/MAFLD with CVD. It focuses on shared metabolic disturbances, inflammatory pathways, and alterations in the gut microbiota that contribute to hepatic and cardiovascular pathology. Review and Gaps: Current evidence highlights insulin resistance, dyslipidemia, systemic inflammation, and gut dysbiosis as pivotal factors connecting NAFLD\/MAFLD to CVD. Despite these insights, inconsistencies in diagnostic criteria and a lack of validated non-invasive biomarkers hinder a clear understanding of the causal relationship between liver and cardiovascular diseases. Conclusions: Addressing these knowledge gaps through standardized diagnostic protocols and large-scale longitudinal studies is essential. Improved biomarker validation and clearer delineation of the underlying mechanisms will improve cardiovascular risk stratification and enable more personalized therapeutic strategies for patients with NAFLD\/MAFLD.<\/jats:p>","DOI":"10.3390\/metabo15030149","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T05:36:47Z","timestamp":1740375407000},"page":"149","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Cardiovascular Manifestations of Patients with Non-Alcoholic Fatty Liver Disease"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7398-5689","authenticated-orcid":false,"given":"Vlad","family":"P\u0103dureanu","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3341-1442","authenticated-orcid":false,"given":"Mircea C\u0103t\u0103lin","family":"For\u021bofoiu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mircea","family":"P\u00eer\u0219coveanu","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodica","family":"P\u0103dureanu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3990-6483","authenticated-orcid":false,"given":"Dumitru","family":"R\u0103dulescu","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6338-2657","authenticated-orcid":false,"given":"Ionu\u021b","family":"Donoiu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denisa Floriana Vasilica","family":"P\u00eer\u0219coveanu","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jhep.2018.10.033","article-title":"Non-alcoholic fatty liver disease\u2014A global public health perspective","volume":"70","author":"Younossi","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"8263","DOI":"10.3748\/wjg.v23.i47.8263","article-title":"Clinical epidemiology and disease burden of nonalcoholic fatty liver disease","volume":"23","author":"Perumpail","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_3","unstructured":"Bertot, L.C., and Adams, L. (2016). The natural course of non-alcoholic fatty liver disease. Int. J. Mol. Sci., 15."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1016\/S0016-5085(99)70506-8","article-title":"Nonalcoholic fatty liver disease: A spectrum of clinical and pathological severity","volume":"116","author":"Matteoni","year":"1999","journal-title":"Gastroenterology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1111\/j.1478-3231.2008.01718.x","article-title":"Prevalence and associated factors of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus","volume":"29","author":"Leite","year":"2009","journal-title":"Liver Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.1023\/A:1005661516165","article-title":"Fatty infiltration of liver in hyperlipidemic patients","volume":"45","author":"Assy","year":"2000","journal-title":"Dig. Dis. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"168","DOI":"10.5009\/gnl19069","article-title":"Extrahepatic manifestations of non-alcoholic fatty liver disease","volume":"14","author":"Li","year":"2020","journal-title":"Gut Liver"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.3892\/etm.2021.10790","article-title":"Non-alcoholic fatty liver disease and hematologic manifestations (Review)","volume":"22","author":"Dop","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1136\/gutjnl-2017-313884","article-title":"Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases","volume":"66","author":"Adams","year":"2017","journal-title":"Gut"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1053\/j.gastro.2015.04.043","article-title":"Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease","volume":"149","author":"Angulo","year":"2015","journal-title":"Gastroenterology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1002\/hep.27368","article-title":"Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up","volume":"61","author":"Ekstedt","year":"2015","journal-title":"Hepatology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1053\/j.gastro.2019.06.026","article-title":"Trends in mortality from extrahepatic complications in patients with chronic liver disease, from 2007 through 2017","volume":"157","author":"Kim","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2324","DOI":"10.1016\/j.cgh.2019.12.026","article-title":"Nonalcoholic fatty liver disease and fibrosis associated with increased risk of cardiovascular events in a prospective study","volume":"18","author":"Baratta","year":"2020","journal-title":"Clin. Gastroenterol. Hepatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/s00125-019-05024-3","article-title":"Non-alcoholic fatty liver disease and cardiovascular disease: Assessing the evidence for causality","volume":"63","author":"Brouwers","year":"2020","journal-title":"Diabetologia"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.jhep.2016.05.013","article-title":"Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: A meta-analysis","volume":"65","author":"Targher","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"20420188221145549","DOI":"10.1177\/20420188221145549","article-title":"MAFLD: A Multisystem Disease","volume":"14","author":"Pipitone","year":"2023","journal-title":"Ther. Adv. Endocrinol. Metab."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.jhep.2020.03.039","article-title":"A New Definition for Metabolic Dysfunction-Associated Fatty Liver Disease: An International Expert Consensus Statement","volume":"73","author":"Eslam","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"20420188221139101","DOI":"10.1177\/20420188221139101","article-title":"MAFLD: What 2\u2009Years of the Redefinition of Fatty Liver Disease Has Taught Us","volume":"13","author":"Grabherr","year":"2022","journal-title":"Ther. Adv. Endocrinol. Metab."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2691","DOI":"10.1210\/clinem\/dgac321","article-title":"Global prevalence and clinical characteristics of metabolic-associated fatty liver disease: A meta-analysis and systematic review of 10 739 607 individuals","volume":"107","author":"Chan","year":"2022","journal-title":"J. Clin. Endoc. Metab."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e573","DOI":"10.1016\/j.cgh.2021.02.030","article-title":"Estimating global prevalence of metabolic dysfunction-associated fatty liver disease in overweight or obese adults","volume":"20","author":"Liu","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1053\/j.gastro.2008.01.075","article-title":"Liver, muscle, and adipose tissue insulin action is directly related to intrahepatic triglyceride content in obese subjects","volume":"134","author":"Korenblat","year":"2008","journal-title":"Gastroenterology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/j.jacc.2018.11.050","article-title":"Nonalcoholic fatty liver disease and the heart","volume":"73","author":"Stahl","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1093\/eurheartj\/ehz962","article-title":"Low-density lipoproteins cause atherosclerotic cardiovascular disease: Pathophysiological, genetic, and therapeutic insights: A consensus statement from the European Atherosclerosis Society Consensus Panel","volume":"41","author":"Boren","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1089\/met.2019.0115","article-title":"High-risk atherosclerosis and metabolic phenotype: The roles of ectopic adiposity, atherogenic dyslipidemia, and inflammation","volume":"18","author":"Lechner","year":"2020","journal-title":"Metab. Syndr. Relat. Disord."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.jhep.2016.04.005","article-title":"Nonalcoholic fatty liver disease and cardiovascular risk: Pathophysiological mechanisms and implications","volume":"65","author":"Francque","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1159\/000450866","article-title":"Metabolic vascular syndrome: New insights into a multidimensional network of risk factors and diseases","volume":"32","author":"Scholz","year":"2016","journal-title":"Visc. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/1475-2891-12-37","article-title":"M. Plasmatic higher levels of homocysteine in Non-alcoholic fatty liver disease (NAFLD)","volume":"12","author":"Muniz","year":"2013","journal-title":"Nutr. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"21202","DOI":"10.3390\/ijms151121202","article-title":"Plasma levels of homocysteine and cysteine increased in pediatric NAFLD and strongly correlated with severity of liver damage","volume":"15","author":"Pastore","year":"2014","journal-title":"Int. J. Mol. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.jhep.2014.03.013","article-title":"Procoagulant imbalance in patients with non-alcoholic fatty liver disease","volume":"61","author":"Tripodi","year":"2014","journal-title":"J. Hepatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1038\/nrendo.2017.56","article-title":"Hepatokines: Linking non-alcoholic fatty liver disease and insulin resistance","volume":"13","author":"Meex","year":"2017","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1038\/nrendo.2012.258","article-title":"The role of hepatokines in metabolism","volume":"9","author":"Stefan","year":"2013","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1161\/CIRCULATIONAHA.111.067264","article-title":"Body fat distribution and risk of cardiovascular disease","volume":"126","author":"Despres","year":"2012","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2360","DOI":"10.1016\/j.jacc.2018.03.509","article-title":"Epicardial adipose tissue may mediate deleterious effects of obesity and inflammation on the myocardi-um","volume":"71","author":"Packer","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"984","DOI":"10.3945\/ajcn.117.157115","article-title":"Dynamics of intrapericardial and extrapericardial fat tissues during longterm, dietary-induced, moderate weight loss","volume":"106","author":"Tsaban","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1002\/hep.27490","article-title":"Transmembrane 6 superfamily member 2 gene variant disentangles non-alcoholic steatohepatitis from cardiovascular disease","volume":"61","author":"Dongiovanni","year":"2015","journal-title":"Hepatology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1093\/eurheartj\/ehx662","article-title":"Liver fat content, non-alcoholic fatty liver disease, and ischaemic heart disease: Mendelian randomization and meta-analysis of 279 013 individuals","volume":"39","author":"Lauridsen","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1038\/s41575-020-0269-9","article-title":"Gut microbiota and human NAFLD: Disentangling microbial signatures from metabolic disorders","volume":"17","author":"Vigliotti","year":"2020","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1111\/jgh.15071","article-title":"Phenotyping non-alcoholic fatty liver disease by the gut microbiota: Ready for prime time?","volume":"35","author":"Demir","year":"2020","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Ma, J., and Li, H. (2018). The role of gut microbiota in atherosclerosis and hypertension. Front. Pharmacol., 9.","DOI":"10.3389\/fphar.2018.01082"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1016\/j.jacc.2019.03.024","article-title":"Intestinal microbiota in cardiovascular health and disease","volume":"73","author":"Tang","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1038\/s41467-019-09455-9","article-title":"A gut microbiome signature for cirrhosis due to nonalcoholic fatty liver disease","volume":"10","author":"Caussy","year":"2019","journal-title":"Nat. Commun."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1002\/hep.28572","article-title":"Gut microbiota pro:ling of pediatric nonalcoholic fatty liver disease and obese patients unveiled by an integrated metaomics-based approach","volume":"65","author":"Nobili","year":"2017","journal-title":"Hepatology"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Da Silva, H.E., Teterina, A., Comelli, E.M., Taibi, A., Arendt, B.M., Fischer, S.E., Lou, W., and Johane P Allard, J.P. (2018). Nonalcoholic fatty liver disease is associated with dysbiosis independent of body mass index and insulin resistance. Sci. Rep., 8.","DOI":"10.1038\/s41598-018-19753-9"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1172\/JCI94601","article-title":"l-Carnitine in omnivorous diets induces an atherogenic gut microbial pathway in humans","volume":"129","author":"Koeth","year":"2018","journal-title":"J. Clin. Investig."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s12933-018-0762-4","article-title":"Association between insulin resistance and the development of cardiovascular disease","volume":"17","author":"Ormazabal","year":"2018","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1016\/j.cgh.2014.10.008","article-title":"Severity of nonalcoholic fatty liver disease and progression to cirrhosis are associated with atherogenic lipoprotein profile","volume":"13","author":"Siddiqui","year":"2015","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Vekic, J., Zeljkovic, A., Cicero, A.F.G., Janez, A., Pantea Stoian, A., Sonmez, A., and Rizzo, M. (2022). Atherosclerosis development and progression: The role of atherogenic small, dense LDL. Medicina, 58.","DOI":"10.3390\/medicina58020299"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"101215","DOI":"10.1016\/j.diabet.2020.101215","article-title":"NAFLD, and cardiovascular and cardiac diseases: Factors influencing risk, prediction and treatment","volume":"47","author":"Targher","year":"2021","journal-title":"Diabetes Metab."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1172\/JCI29069","article-title":"Inflammation and insulin resistance","volume":"116","author":"Shoelson","year":"2006","journal-title":"J. Clin. Investig."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1056\/NEJMra0912063","article-title":"Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease","volume":"363","author":"Targher","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.ihj.2014.08.006","article-title":"Prevalence of nonalcoholic fatty liver disease (NAFLD) in patients of cardiovascular diseases and its association with hs-CRP and TNF-\u03b1","volume":"66","author":"Ajmal","year":"2014","journal-title":"Indian Heart J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1417962","DOI":"10.1155\/2016\/1417962","article-title":"Pentraxin 3 is a predictor for fibrosis and arterial stiffness in patients with nonalcoholic fatty liver disease","volume":"2016","author":"Ozturk","year":"2016","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_53","first-page":"169","article-title":"The gut microbiome, diet, and links to cardiometabolic and chronic disorders","volume":"12","year":"2015","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), and European Association for the Study of Obesity (EASO) (2016). EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. Obes. Facts., 9, 65\u201390.","DOI":"10.1159\/000443344"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.2337\/dc06-2247","article-title":"Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients","volume":"30","author":"Targher","year":"2007","journal-title":"Diabetes Care"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"389","DOI":"10.2337\/dc11-1820","article-title":"Nonalcoholic fatty liver disease is associated with left ventricular diastolic dysfunction in patients with type 2 diabetes","volume":"35","author":"Bonapace","year":"2012","journal-title":"Diabetes Care"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1002\/hep.26156","article-title":"Association between non invasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States","volume":"57","author":"Kim","year":"2013","journal-title":"Hepatology"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1136\/gutjnl-2016-311854","article-title":"Non-alcoholic fatty liver disease and progression of coronary artery calcium score: A retrospective cohort study","volume":"66","author":"Sinn","year":"2017","journal-title":"Gut"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jhep.2016.02.023","article-title":"Fatty liver is an independent predictor of early carotid atherosclerosis","volume":"65","author":"Pais","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/S2468-1253(21)00308-3","article-title":"Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: An updated systematic review and meta-analysis","volume":"6","author":"Mantovani","year":"2021","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1097\/CM9.0000000000001513","article-title":"Cardiovascular and renal burdens of metabolic associated fatty liver disease from serial US national surveys, 1999\u20132016","volume":"134","author":"Zhang","year":"2021","journal-title":"Chin. Med. J."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1016\/j.jhep.2014.11.030","article-title":"Epicardial fat, cardiac geometry and cardiac function in patients with non-alcoholic fatty liver disease:association with the severity of liver disease","volume":"62","author":"Petta","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2021). EASL clinical practice guidelines on non-invasive tests for evaluation of liver disease severity and prognosis\u20142021 update. J. Hepatol., 75, 659\u2013689.","DOI":"10.1016\/j.jhep.2021.05.025"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"617","DOI":"10.3109\/07853890.2010.518623","article-title":"Metaanalysis: Natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity","volume":"43","author":"Musso","year":"2011","journal-title":"Ann. Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.cgh.2011.12.039","article-title":"Independent association between nonalcoholic fatty liver disease and cardiovascular disease in the US population","volume":"10","author":"Stepanova","year":"2012","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-018-30465-y","article-title":"The impact of non-alcoholic fatty liver disease and metabolic syndrome on the progression of coronary artery calcification","volume":"8","author":"Cho","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1016\/j.amjcard.2017.03.010","article-title":"Frequency of non-alcoholic fatty liver disease and subclinical atherosclerosis among young Mexican Americans","volume":"119","author":"Gill","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1002\/hep4.1155","article-title":"Nonalcoholic fatty liver disease contributes to subclinical atherosclerosis: A systematic review and meta-analysis","volume":"2","author":"Zhou","year":"2018","journal-title":"Hepatol. Commun."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1136\/gutjnl-2018-317666","article-title":"Alcoholic and non-alcoholic fatty liver disease and associations with coronary artery calcification: Evidence from the Kangbuk Samsung Health Study","volume":"68","author":"Chang","year":"2019","journal-title":"Gut"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.amjcard.2019.05.028","article-title":"Nonalcoholic fatty liver disease is associated with arterial distensibility and carotid intima-media thickness: (from the multi-ethnic study of atherosclerosis)","volume":"124","author":"Oni","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1186\/s12944-018-0913-3","article-title":"A longitudinal epidemiological study on the triglyceride and glucose index and the incident nonalcoholic fatty liver disease","volume":"17","author":"Zheng","year":"2018","journal-title":"Lipids Health Dis."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Zheng, J., Zhou, Y., Zhang, K., Qi, Y., An, S., Wang, S., Zhao, X., and Tang, Y.-D. (2018). Association between nonalcoholic fatty liver disease and subclinical atherosclerosis: A cross-sectional study on population over 40 years old. BMC Cardiovasc. Disord., 18.","DOI":"10.1186\/s12872-018-0877-2"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1111\/liv.14322","article-title":"Associations of subclinical atherosclerosis with nonalcoholic fatty liver disease and fibrosis assessed by non-invasive score","volume":"40","author":"Xin","year":"2020","journal-title":"Liver Int."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.jvs.2019.03.044","article-title":"The association between liver fat and systemic calcified atherosclerosis","volume":"71","author":"Koo","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1825142","DOI":"10.1155\/2020\/1825142","article-title":"Endothelial dysfunction, a marker of atherosclerosis, is independent of metabolic syndrome in NAFLD patients","volume":"2020","author":"Narayan","year":"2020","journal-title":"Int. J. Hepatol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1253\/circj.72.618","article-title":"Evaluation of vulnerable coronary plaques and non-alcoholic fatty liver disease (NAFLD) by 64-detector multislice computed tomography (MSCT)","volume":"72","author":"Akabame","year":"2007","journal-title":"Circ. J."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s00392-020-01709-7","article-title":"NAFLD and cardiovascular diseases: A clinical review","volume":"110","author":"Kasper","year":"2020","journal-title":"Clin. Res. Cardiol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1016\/j.amjcard.2017.07.107","article-title":"Effect of nonalcoholic fatty liver disease on in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction","volume":"120","author":"Keskin","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Bonapace, S., Valbusa, F., Bertolini, L., Pichiri, I., Mantovani, A., Rossi, A., Zenari, L., Barbieri, E., and Targher, G. (2014). Nonalcoholic fatty liver disease is associated with aortic valve sclerosis in patients with type 2 diabetes mellitus. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0088371"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1136\/gutjnl-2020-320622","article-title":"NAFLD and increased risk of cardiovascular disease: Clinical associations, pathophysiological mechanisms and pharmacological implications","volume":"69","author":"Targher","year":"2020","journal-title":"Gut"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.numecd.2014.01.005","article-title":"Association of nonalcoholic fatty liver disease with QTc interval in patients with type 2 diabetes","volume":"24","author":"Targher","year":"2014","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Targher, G., Valbusa, F., Bonapace, S., Bertolini, L., Zenari, L., Rodella, S., Zoppini, G., Mantovani, W., Barbieri, E., and Byrne, C.D. (2013). Non-alcoholic fatty liver disease is associated with an increased incidence of atrial fibrillation in patients with type 2 diabetes. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0057183"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Karajamaki, A.J., Patsi, O.P., Savolainen, M., Kesaniemi, Y.A., Huikuri, H., and Ukkola, O. (2015). Non-alcoholic fatty liver disease as a predictor of atrial brillation in middle-aged population (OPERA study). PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0142937"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.2337\/dc16-0091","article-title":"Nonalcoholic fatty liver disease is associated with ventricular arrhythmias in patients with type 2 diabetes referred for clinically indicated 24-hour holter monitoring","volume":"39","author":"Mantovani","year":"2016","journal-title":"Diabetes Care"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1111\/bph.14481","article-title":"The bidirectional interaction between the sympathetic nervous system and immune mechanisms in the pathogenesis of hypertension","volume":"176","author":"Carnagarin","year":"2019","journal-title":"Br. J. Pharmacol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1161\/HYPERTENSIONAHA.119.13419","article-title":"Nonalcoholic fatty liver disease","volume":"75","author":"Zhao","year":"2020","journal-title":"Hypertension"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"5722","DOI":"10.36922\/bh.5722","article-title":"Stroke risk among Nigerians with diabetes and hypertension: A pilot retrospective cohort study","volume":"3","author":"Abbdullahi","year":"2025","journal-title":"Brain Heart"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Huh, J.H., Ahn, S.V., Koh, S.B., Choi, E., Kim, J.Y., Sung, K.-C., Kim, E.J., and Jeong Bae Park, J.B. (2015). A prospective study of fatty liver index and incident hypertension: The KoGESARIRANG study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0143560"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1097\/HJH.0b013e32833c211b","article-title":"The association between fatty liver disease and blood pressure in a population-based prospective longitudinal study","volume":"28","author":"Lau","year":"2010","journal-title":"J. Hypertens."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1097\/HJH.0000000000001245","article-title":"Association between MRI-derived hepatic fat fraction and blood pressure in participants without history of cardiovascular disease","volume":"35","author":"Lorbeer","year":"2017","journal-title":"J. Hypertens."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1926","DOI":"10.1111\/jgh.12643","article-title":"Clinical association between non-alcoholic fatty liver disease and the development of hypertension","volume":"29","author":"Ryoo","year":"2014","journal-title":"J. Gastroenterol. 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