Link Between Liver Disease and Heart Failure

Recent research highlights a significant connection between a widespread liver disease that impacts nearly 90 million Americans and heart failure, revealing that almost half of those affected show initial signs of heart damage.

A study conducted by researchers at Duke University analyzed health records of 570 patients from their hospital system, all diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD), previously referred to as non-alcoholic fatty liver disease (NAFLD). Current statistics indicate that more than 86 million Americans are grappling with this condition.

The research tracked the health outcomes of these individuals for 11 years following their MASLD diagnosis, a condition where excess fat accumulates in the liver, leading to inflammation and scarring over time.

Over this period, nearly 20% of the participants developed heart failure, while almost half exhibited early heart failure symptoms without any formal cardiac diagnosis.

The prevalence of MASLD in the U.S. is quite significant—it affects more than one in three adults on average. This disease arises when the body struggles to process fats and sugars, often advancing without obvious symptoms until it reaches a critical, potentially irreversible state.

Interestingly, individuals at the onset of the disease might possess a considerable amount of liver fat and some scarring but feel perfectly fine, which allows the condition to progress largely unnoticed for years, perhaps even decades.

The latest findings indicate that as MASLD gradually scars the liver, impairing its ability to filter toxins from the bloodstream, the heart simultaneously weakens, becoming more susceptible to failure. However, only 5% of the patients in this study had been diagnosed with heart failure prior.

Dr. Marat Fudim, a researcher at Duke and co-author of the study, pointed out, “These results underscore a significant oversight in recognizing and diagnosing heart failure in this high-risk population.”

Specifically, researchers chosen for the study had confirmed MASLD via liver biopsy, considered ‘the gold standard for diagnosis,’ according to Dr. Fudim, as it offers the most precise assessment.

The subjects had been diagnosed with MASLD between 2007 and 2013 and were monitored until their death or until January 2023, with an average study population age of around 50. Remarkably, less than 2% were diagnosed with heart failure before having the liver biopsy.

Among the study group, nearly 40% had diabetes, 59% suffered from high blood pressure, and close to 60% had elevated blood lipid levels.

During the follow-up, 71 patients (12.5%) passed away. Of these, nine deaths were linked to liver issues, three to cardiovascular problems, and 23 to other known causes, while 36 patients had undetermined causes due to manual chart reviews.

Remarkably, during the study, 100 patients met criteria for heart failure despite not being formally diagnosed. Among those with advanced liver scarring, 33% were found to have heart failure when the study concluded.

Key risk factors included age and being female, likely due to declining estrogen levels that protect against liver dysfunction as women age. Other conditions, like diabetes and hypertension, also heightened the risk.

The researchers also examined early warning signs of heart failure—such as shortness of breath, swelling, irregular heartbeat, and dizziness—while assessing hospitalizations for heart-related issues and blood test markers signaling heart strain. Their findings indicated that many more individuals exhibited signs of heart problems than those who actually developed diagnosable heart failure.

Around half of all participants showed early warning signs throughout the study. In the U.S., approximately 6.7 million people live with heart failure, responsible for nearly 8.5% of heart disease fatalities.

Dr. Kara Wegermann, a Duke gastroenterologist and lead author, stated, “Our research highlights the underdiagnosis of heart failure and the lack of acknowledgment regarding diastolic dysfunction in MASLD patients.” She emphasized, “There’s a genuine opportunity to create better screening methods to identify these individuals sooner or even help prevent symptomatic heart failure.”

Based on their findings, the authors of the study strongly advocated for targeted heart screenings for patients with MASLD at heightened risk. They suggest individuals with diabetes, high cholesterol, or those who are female should receive routine heart evaluations, enabling earlier detection of heart failure and potentially improving patient outcomes.