To the Editor:

In recent years, the potential association between nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) has attracted much interest,1 generating discussion that NAFLD patients should perhaps be treated not only for their liver disorder but also owing to their associated cardiovascular risk factors. However, it seems that at present we cannot draw a definitive conclusion on the association between NAFLD and CVD. I read with great interest the article by Ghouri et al.,2 who reviewed data from recent prospective studies and concluded that a diagnosis of NAFLD is insufficient to consider patients as being at high risk for CVD. Nevertheless, it is interesting to note that Targher et al.3 recently reviewed the rapidly growing body of clinical evidence supporting a strong link between NAFLD and the CVD risk. Therefore, additional effort is encouraged to shed light on the link between the two disorders.

I do not intend to judge the association between NAFLD and CVD; however, I sincerely hope the current debatable status will not hamper the research community to optimize the treatment strategy. Before drawing a definitive conclusion on the association between the two disorders, I submit that the NAFLD treatment strategy, which also possesses the potential to prevent/reduce the associated risk of CVD, may serve as a good approach for NAFLD patients. The advantage of this strategy is that if no or only a weak association between NAFLD and CVD is found, the approach will not bring additional burden to the patients. There have been numerous clinical trials of various treatment modalities for NAFLD as comprehensively reviewed by Lam and Younossi,4 including weight loss agents, insulin-sensitizing agents, lipid-lowering agents, antioxidants, probiotics, and other novel compounds. In addition, Satapathy and Sanyal5 recently discussed the status of current and emerging treatment strategies for nonalcoholic steatohepatitis patients and highlighted the great potential of antioxidant therapy. Because the treatment strategies for NAFLD and CVD are similar, it is promising to consider that one of the above-mentioned treatment modalities for NAFLD could also be applied for associated risk of CVD.


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  • 1
    Targher G, Marra F, Marchesini G. Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: causal effect or epiphenomenon? Diabetologia 2008; 51: 1947-1953.
  • 2
    Ghouri N, Preiss D, Sattar N. Liver enzymes, nonalcoholic fatty liver disease, and incident cardiovascular disease: a narrative review and clinical perspective of prospective data. HEPATOLOGY 2010; 52: 1156-1161.
  • 3
    Targher G, Day CP, Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med 2010; 363: 1341-1350.
  • 4
    Lam B, Younossi ZM. Treatment options for nonalcoholic fatty liver disease. Therap Adv Gastroenterol 2010; 3: 121-137.
  • 5
    Satapathy SK, Sanyal AJ. Novel treatment modalities for nonalcoholic steatohepatitis. Trends Endocrinol Metab 2010; 21: 668-675.

Liang Shen Ph.D.*, * Shandong Provincial Research Center for Bioinformatic Engineering and Technique, Shandong University of Technology, Zibo, P. R. China.