Researchers at Mass General Brigham Heart and Vascular Institute found that people with hepatic steatosis, commonly called "fatty liver disease," have a higher amount of noncalcified, rupture-prone coronary plaque and face nearly twice the rate of cardiovascular events compared to those without steatosis. The findings, published in Clinical Gastroenterology and Hepatology , suggest cardiac CT scans may offer an opportunity to identify patients who could benefit from more aggressive prevention strategies.
"Our findings highlight that fatty liver disease is not only a liver condition but also an important marker of heart disease risk," said lead author Jan Brendel, MD, a postdoctoral research fellow in the Cardiovascular Imaging Research Center with the Mass General Brigham Heart and Vascular Institute. "Fatty liver disease can be detected on routine cardiac CT scans and could help guide earlier, preventive treatment."
To investigate the association between hepatic steatosis, which affects an estimated 30-40% of U.S. adults, and cardiovascular health, researchers analyzed data from 3,637 participants of the PROMISE trial, a large multicenter study of patients evaluated for chest pain. Using cardiac CT scans, the team measured coronary plaque volume and composition and also assessed hepatic steatosis, as portions of the liver are often visible within the scan field. CT results showed that just over 25% of participants had hepatic steatosis.
Imaging revealed that patients with hepatic steatosis had a 24% increase in noncalcified plaque volume and a 15% increase in total and noncalcified plaque burden compared to people without hepatic steatosis. Noncalcified plaque is a softer form of plaque that is more likely to rupture and trigger a blood clot than calcified plaque.
Over a median follow-up of 25 months, patients with hepatic steatosis were more likely to experience major adverse cardiovascular events, including death, heart attack, or hospitalization for unstable angina, compared with those without steatosis (4.1% vs. 2.5%). Even after adjusting for cardiovascular risk factors, hepatic steatosis remained associated with a 69% higher risk of major adverse cardiovascular events. Noncalcified plaque burden accounted for 11% of the increased cardiovascular risk associated with hepatic steatosis. These findings suggest that high-risk plaque may be an important link between liver disease and heart disease.
The researchers say future studies should examine whether therapies such as high-intensity statins or GLP-1 receptor agonists can reduce the burden of high-risk plaque in patients with hepatic steatosis.
Authorship: In addition to Brendel, Mass General Brigham authors include Nóra M. Kerkovits, Sara Ersözlü, Kathleen E. Corey, Nandini M. Meyersohn, Michael T. Lu, and Borek Foldyna. Additional authors include Thomas Mayrhofer, Márton Kolossváry, Brooke Alhanti, Neha Pagidipati, Svati H. Shah, Maros Ferencik, Stefania Lamon-Fava, Udo Hoffmann, and Pamela S. Douglas.
Disclosures: Brendel is funded by the German Research Foundation (540505270). Additional disclosures can be found in the paper.
Funding: This study was supported by the National Institutes of Health/National Heart, Lung, and Blood Institute (R01HL098236, R01HL098237, R01HL098305, 1R01HL170877, and R01HL146145). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Paper cited: Brendel JM et al. "Hepatic Steatosis Is Associated with Increased Cardiovascular Risk Through Adverse Coronary Plaque Composition" Clinical Gastroenterology and Hepatology DOI: 10.1016/j.cgh.2026.04.022
