Conversations about heart disease tend to circle the same three subjects: cholesterol, blood pressure, lifestyle. There is a fourth player that rarely gets equal billing — the liver.¹
A two-way relationship
Cardiovascular disease and liver disease are more tightly linked than most people expect. Non-alcoholic fatty liver disease (NAFLD) — since formally renamed metabolic dysfunction-associated steatotic liver disease, or MASLD — shares much of its risk profile with atherosclerotic cardiovascular disease (ASCVD), the condition in which excess cholesterol and inflammation drive plaque to accumulate inside the arteries. The shared risk factors include:¹
Obesity
Diabetes
High blood pressure
High cholesterol
And the traffic runs in both directions: an unhealthy liver raises cardiac risk, while a struggling heart puts the liver at risk in turn.¹
Cholesterol: the key connection
Among the strongest predictors of cardiovascular disease is high cholesterol — and the organ responsible for keeping cholesterol in balance is the liver.²
Cholesterol is not inherently harmful. The body needs it to build cell membranes and manufacture hormones. Problems begin when levels climb too far: surplus cholesterol accumulates within artery walls, sets atherosclerosis in motion, and leads toward clogged arteries, heart attacks and strokes.²
Since the liver is the main control centre for cholesterol, any disruption to how it manages fat and lipids can tip the balance toward disease quickly. Overload it — with excess sugar, saturated fats, alcohol or chronic inflammation — and its ability to process and package cholesterol efficiently begins to fail. Fat starts collecting inside liver cells, which changes how cholesterol is synthesised, stored and released into the bloodstream.²
The consequences follow: more harmful fats circulating, more stress on the blood vessels, higher risk of heart disease. Research bears this out — cardiovascular disease is the leading cause of death among people with NAFLD, now recognised as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).
If cholesterol numbers are already a concern, this piece on high cholesterol and headaches walks through the everyday symptoms worth watching for.
Why it matters
With populations ageing and obesity rates still climbing, both heart disease and liver disease are growing more common. They are usually treated as separate problems, yet they are deeply entangled, and looking at them together produces a far clearer picture of a person's health.¹
The encouraging conclusion is that protecting either organ protects the other. Steps taken to support the liver lower cardiovascular risk, and caring for the heart gives the liver a better chance of staying healthy.
References
Cited by the original article:
Nakashima M, Nakamura K, Nishihara T, et al. Association between Cardiovascular Disease and Liver Disease, from a Clinically Pragmatic Perspective as a Cardiologist. Nutrients. 2023;15(3):748. doi:10.3390/nu15030748
Trapani L, Segatto M, Pallottini V. Regulation and deregulation of cholesterol homeostasis: The liver as a metabolic "power station". World J Hepatol. 2012;4(6):184-190. doi:10.4254/wjh.v4.i6.184
