What Is the Connection Between Liver Health and Heart Disease? A Cardiologist Answers

The liver and the heart have different roles and functions, but they are closely connected. The liver processes nutrients, removes toxins, stores energy, and helps regulate cholesterol and blood sugar. The heart pumps blood around the body, supplying oxygen and nutrients to every organ. When the liver becomes unhealthy, it can affect many of the same processes that influence heart health.

A study published in the journal 'Clinical Gastroenterology and Hepatology' shows that
people with chronic liver disease, particularly fatty liver disease, are more likely to develop cardiovascular disease. In fact, heart disease is one of the leading causes of death in people with fatty liver disease.

How Are The Liver And Heart Connected?

The liver plays a central role in metabolism. It helps with the following:

• Produce and process cholesterol
• Regulate blood sugar
• Store vitamins and minerals
• Break down fats
• Remove harmful substances from the blood
• Produce proteins involved in blood clotting

“When the liver is working well, these functions help maintain overall health. However, when liver function is affected, it can lead to changes that increase the risk of cardiovascular disease,” shares Dr Deebanshu Gupta, Cardiologist at Sarvodya Hospital, Jalandhar.

What Is Fatty Liver Disease?

Fatty liver disease occurs when excess fat builds up in the liver. There are two main types:

• Non-alcoholic fatty liver disease (NAFLD): Fat accumulation not caused by excessive alcohol intake.
• Alcohol-related liver disease: Fatty changes caused by long-term heavy alcohol consumption.

A newer medical term, Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), is increasingly being used to describe fatty liver linked to obesity, type 2 diabetes and other metabolic conditions.

Many people with fatty liver disease have no symptoms, especially in the early stages. It is often discovered during routine blood tests or ultrasound scans.

Why Does Fatty Liver Increase Heart Disease Risk?

Fatty liver disease is not simply a liver problem. It reflects underlying metabolic changes that also affect the heart and blood vessels. Taking insights from the findings published in the Cureus Journal of Medical Science, here are some prominent factors that contribute to this increased risk.

Chronic inflammation

Fat accumulation in the liver triggers ongoing inflammation. Inflammation does not remain confined to the liver. It releases inflammatory chemicals into the bloodstream, which can damage blood vessels.

Damaged blood vessels are more likely to develop atherosclerosis, the build-up of fatty plaques that narrow the arteries and increase the risk of heart attack and stroke.

Insulin resistance

Many people with fatty liver disease also have insulin resistance. This means the body's cells do not respond properly to insulin, causing blood sugar levels to rise. Insulin resistance increases the likelihood of:

• Type 2 diabetes
• High blood pressure
• High triglyceride levels
• Low HDL or good cholesterol

These are all well-established risk factors for cardiovascular disease.

Unhealthy cholesterol levels

The liver is responsible for producing and processing cholesterol. When liver metabolism is disrupted, cholesterol levels may become abnormal. People with fatty liver disease often have:

• High LDL or bad cholesterol
• High triglycerides
• Low HDL cholesterol

This combination encourages plaque formation inside arteries.

High blood pressure

Fatty liver disease is frequently associated with hypertension. Although the exact reasons are complex, inflammation, insulin resistance and changes in blood vessel function all contribute to raised blood pressure.

According to a report published in the journal 'Diabetes, Metabolic Syndrome and Obesity', researchers used the Triglyceride-Glucose-Body Mass Index to establish hypertension risk in fatty liver disease patients. Besides, high blood pressure forces the heart to work harder and increases the risk of heart attack, stroke, and heart failure.

Obesity and its mutual connection with liver disease and heart disease

Obesity is one of the strongest risk factors for both fatty liver disease and cardiovascular disease. Excess body fat, particularly around the abdomen, promotes:

• Liver fat accumulation
• Chronic inflammation
• Insulin resistance
• High blood pressure
• Abnormal cholesterol levels
• Maintaining a healthy weight therefore benefits both organs.

Also Read: What is the SGOT Test? A Simple Guide to Understanding Your Liver Health

Can Liver Disease Affect The Heart Directly?

Advanced liver disease can affect the heart in several ways. People with severe liver disease may develop changes in blood circulation that force the heart to work differently. Some may develop:

• Irregular heart rhythms
• Heart muscle abnormalities
• Changes in blood pressure regulation
• Fluid retention that places additional strain on the heart

These complications are more common in advanced liver disease such as cirrhosis.

Does Heart Disease Affect The Liver?

The relationship works both ways.

According to a report published in the Journal of Cardiac Failure - Intersections, when the heart is unable to pump blood efficiently, as in heart failure, blood can back up into the liver.

This reduces oxygen delivery and increases pressure inside the liver, potentially causing liver damage over time. This condition is sometimes called congestive hepatopathy.

Who Is At Higher Risk?

Several factors increase the likelihood of developing both liver disease and heart disease, such as:

• Obesity
• Type 2 diabetes
• High cholesterol
• High blood pressure
• Physical inactivity
• Smoking
• An unhealthy diet rich in processed foods
• Excessive alcohol consumption

Because these conditions share many risk factors, they often occur together.

Warning Signs To Watch For

Fatty liver disease often causes no symptoms. When symptoms occur, they may include:

• Tiredness
• Discomfort in the upper right side of the abdomen
• Unexplained weakness
• Heart disease may present with:
• Chest pain
• Shortness of breath
• Palpitations
• Swollen ankles
• Dizziness
• Fatigue during physical activity

Anyone experiencing these symptoms should seek medical advice promptly.

How Are Liver And Heart Health Assessed?

Doctors may recommend several tests depending on individual risk factors.

For liver health:

• Liver function blood tests
• Ultrasound scan
• Fibrosis assessment
• MRI in selected cases

For heart health:

• Blood pressure measurement
• Cholesterol testing
• Blood sugar testing
• Electrocardiogram (ECG)
• Echocardiogram if needed
• Cardiovascular risk assessment

People diagnosed with fatty liver disease may benefit from regular cardiovascular evaluation because of their increased risk.

Can Improving Liver Health Reduce Heart Risk?

According to a study published in the World Journal of Cardiology, many lifestyle changes improve both liver and cardiovascular health simultaneously. These include:

• Maintaining a healthy weight: Losing even 5-10% of body weight can reduce liver fat and improve several cardiovascular risk factors.
• Eating a balanced diet: Consuming vegetables and fruit, whole grains, pulses, nuts, fish and healthy fats. Avoiding sugary drinks, processed foods, refined carbohydrates, and foods high in saturated fat.
• Exercising regularly: Aim for at least 150 minutes of moderate physical activity each week. Both aerobic exercise and strength training improve insulin sensitivity, reduce liver fat, and support heart health.
• Controlling diabetes and blood pressure: Managing blood sugar and blood pressure helps reduce complications affecting both organs.
• Avoiding smoking: Smoking damages blood vessels and increases inflammation, worsening both cardiovascular and liver health.
• Limiting alcohol: Even people with non-alcoholic fatty liver disease should avoid excessive alcohol intake, as it can accelerate liver damage.

Final Word

The liver and the heart are closely connected through the body's metabolism, inflammation, and blood vessel health. When the liver becomes unhealthy, particularly because of fatty liver disease, the risk of developing cardiovascular disease increases significantly. This is largely due to shared risk factors such as obesity, diabetes, high blood pressure, unhealthy cholesterol levels and chronic inflammation. Therefore, looking after liver health is not only important for preventing liver complications, but it is also an essential part of protecting long-term heart health.