When we think about heart disease, we often focus on cholesterol, blood pressure, or lifestyle habits. But there’s another key player that doesn’t always get the spotlight: the liver. ¹

A Two-Way Relationship

Cardiovascular disease and liver disease are more connected than you might expect. In fact, non-alcoholic fatty liver disease (NAFLD), now officially renamed metabolic dysfunction-associated steatotic liver disease (MASLD), shares many of the same risk factors as atherosclerotic cardiovascular disease (ASCVD) - when excess cholesterol and inflammation cause plaque to build up inside the arteries. These include: ¹

• Obesity
• Diabetes
• High blood pressure
• High cholesterol
  

The relationship goes both ways: when the liver is unhealthy, heart risk increases; when the heart struggles, the liver is at risk.. ¹

Cholesterol: The Key Connection

One of the strongest predictors of cardiovascular disease is high cholesterol. And here’s the interesting part: the liver is in charge of keeping cholesterol in balance. ²

Cholesterol itself isn’t “bad.” Our bodies need it for important roles like building cell membranes and making hormones. The trouble starts when cholesterol levels climb too high. Excessive cholesterol can build up inside artery walls, triggering atherosclerosis and leading to clogged arteries, heart attacks, and strokes. ²

Because the liver is the main control center for cholesterol, any disruption in how it manages fat and cholesterol can tip the balance toward disease. ²

Because the liver is the body’s main control center for cholesterol, any disruption in how it manages fat and lipids can quickly tip the balance toward disease. When the liver becomes overloaded — through excess sugar, saturated fats, alcohol, or chronic inflammation — its ability to process and package cholesterol efficiently begins to falter. Fat can start to accumulate within liver cells, altering how cholesterol is synthesised, stored, and released into the bloodstream. ²

The result? More harmful fats circulating in the bloodstream, more stress on blood vessels, and a higher risk of heart disease. In fact, research shows that cardiovascular disease is the leading cause of death in people with NAFLD, now recognized as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).

Why It Matters

As the world’s population grows older and obesity rates continue to rise, both heart disease and liver disease are becoming more common. These conditions are often treated separately, but in reality they are deeply connected. Looking at them together gives us a clearer picture of overall health. ¹
The good news? Protecting one organ helps protect the other. By taking steps to support your liver, you also lower your risk of heart disease—and by caring for your heart, you give your liver a better chance to stay healthy too. 

REFERENCES:
¹ 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. Published 2023 Feb 1. doi:10.3390/nu15030748

² 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