Liver Stiffness and Fat Content May Lead to Coronary Heart Disease, Study Suggests

A recent retrospective study has demonstrated the nonlinear positive correlation between liver stiffness and fat content and coronary heart disease (CHD), highlighting a new key indicator for CHD risk.

Liver health has recently become a focal point of cardiovascular disease research, as it holds a central role in metabolism. Recent literature has indicated a correlation between liver disorders, such as fibrosis and fat accumulation, and cardiovascular risk. Liver stiffness, in turn, has been associated with inflammation, metabolic dysregulation, and endothelial dysfunction.1,2

“By elucidating the connections between liver health and CHD, this research intends to provide novel biomarkers and tools for early detection and risk stratification, thereby informing targeted prevention and intervention strategies for cardiovascular disease,” wrote Shengnan Li, department of pharmacy, the Affiliated Cardiovascular Hospital of Qingdao University, and colleagues.1

Investigators collected data from the NHANES database, extracting demographic information, physical examination data, and lab results from 27,493 participants from 2017-2020 and 2021-2023. Participants were excluded if they were missing liver stiffness values (n = 11,093), liver fat values (n = 3), CHD outcome data (n = 2902), educational attainment data (n = 8), or antibody data (n = 799).1

After filtering for exclusion criteria, investigators included 12,684 participants with a mean age of 48.23 +/- 17.11 years. Among these, 539 were diagnosed with CHD. The association between liver stiffness and CHD was measured via transient elastography. It was categorized into quartiles: Q1 (lowest 25%), Q2 (25-50%), Q3 (50-75%), and Q4 (highest 25%).1

Investigators found a consistent positive association between liver stiffness and CHD risk; in an unadjusted model, it was not significant in Q2 (odds ratio [OR] 1.244; P = .16) but was in Q3 (OR 1.514; P = .017) and Q4 (OR 2.303; P <.001). Disease development risk rose in Q3 and Q4 compared to Q1, indicating liver stiffness as a risk factor. Subgroup analysis found that the association between liver stiffness and CHD was significantly affected by race and blood parameters (P-interaction <.05).1

Additionally, the team found a consistently positive association between liver fat and CHD risk. The unadjusted model also did not display significant risk in Q2 (OR 1.181; P = .382), but it did in Q3 (OR 1.689; P = .001) and Q4 (OR 2.336; P <.001). The risk of disease development also rose in Q3 and Q4 compared to Q1. Subgroup analysis showed significant interactions for CHD risk with sex, age, and cholesterol levels (P-interaction < .05).1

Li and colleagues point out that these results challenge the longstanding belief that CHD is driven solely by traditional risk factors, such as hypertension, smoking, and dyslipidemia. The team advocates for a more integrated approach to risk stratification, which includes liver health markers in addition to standard predictors.1

“Future research should prioritize longitudinal studies to elucidate causal pathways and assess the long-term impact of liver health interventions on cardiovascular outcomes,” Li and colleagues wrote. “Advances in omics technologies, including metabolomics, proteomics, and genomics, offer exciting opportunities to uncover novel biomarkers and mechanisms linking liver and cardiovascular health.”1

References

1. Li, S., Li, X., Xiao, H. et al. The relationship between liver stiffness, fat content measured by liver elastography, and coronary artery disease: a study based on the NHANES database. Sci Rep 15, 30010 (2025). https://doi.org/10.1038/s41598-025-15709-y

2. Wu Y, Zhao Q. Refining risk assessment for intra-abdominal infections in immunocompromised intensive care unit patients. Eur J Intern Med. 2025;134:138-139. doi:10.1016/j.ejim.2024.12.025