Short summary: A new study found that fatty liver seen on cardiac CT scans was linked with more higher-risk coronary plaque and a higher rate of heart-related events.
Key takeaways
- Fatty liver disease is common in people with obesity, insulin resistance, and type 2 diabetes.
- A new study linked fatty liver with more noncalcified coronary plaque.
- People with fatty liver had a higher rate of major cardiovascular events during follow-up.
- This was observational, so it cannot prove fatty liver directly caused heart events.
What happened?
Researchers at Mass General Brigham analyzed data from 3,637 participants in the PROMISE trial, a large study of people evaluated for chest pain.
The researchers looked at cardiac CT scans. Because part of the liver can be visible on these scans, they could also assess whether participants had hepatic steatosis, commonly called fatty liver.
Just over 25% of participants had fatty liver. Compared with those without fatty liver, people with fatty liver had more noncalcified coronary plaque. This type of plaque is sometimes considered higher risk because it may be more likely to rupture than heavily calcified plaque.
Over a median follow-up of 25 months, major cardiovascular events occurred in 4.1% of participants with fatty liver compared with 2.5% of those without fatty liver. After adjustment for cardiovascular risk factors, fatty liver remained associated with a 69% higher relative risk of major adverse cardiovascular events.
Why this matters
Fatty liver disease, now often discussed under the broader term metabolic dysfunction-associated steatotic liver disease, is closely linked with insulin resistance, abdominal weight gain, abnormal cholesterol, high blood pressure, and type 2 diabetes.
This study reinforces an important message: fatty liver should not be seen only as a liver issue. It may also be a marker of wider cardiometabolic risk.
For people living with diabetes or prediabetes, that matters because cardiovascular disease remains one of the most important long-term health risks.
What this does not mean
This study does not prove that fatty liver directly causes heart attacks or heart events. It also does not mean that everyone with fatty liver needs a cardiac CT scan.
The participants were people already being evaluated for chest pain, so the findings may not apply in exactly the same way to the general population.
The absolute difference in event rates was also modest: 4.1% versus 2.5% over about two years. That is still important, but it should be explained clearly rather than exaggerated.
Practical takeaway
If fatty liver has been found on blood tests, ultrasound, CT, or another scan, it may be worth discussing overall heart-risk prevention with a healthcare professional. That discussion may include blood pressure, cholesterol, blood glucose, weight, physical activity, nutrition, smoking status, and whether medications such as statins are appropriate.
Sources
Editorial verification note: reviewed for medical accuracy, non-causal wording, absolute risk context, and source consistency. Independent OpenRouter/Perplexity verification passed against the cited sources.