The new study, published in the September 2021 issue of the Scandinavian Journal of Gastroenterology, will be presented September 27 to 29 at the American Heart Association Hypertension Scientific Sessions 2021, a virtual event. It’s the first study to look at the effect of the coexistence of hypertension and fatty liver disease on death. If two risk factors interact with each other to impact an outcome, then a person who has both of them would have a higher or lower risk than the sum of their individual effects.
Many Americans Have Hypertension, Fatty Liver Disease, or Both
Hypertension, or high blood pressure, is the most common risk factor for heart disease. Nearly half of all adults in the United States — 108 million people — have hypertension or are taking a medication for hypertension, according to the Centers for Disease Control and Prevention (CDC). Fatty liver disease (FLD) is when you have fat inside your liver that can eventually impact liver function and cause liver injury; it’s classified as either alcoholic or nonalcoholic. Having overweight or obesity, high LDL (“bad”) cholesterol, and high blood pressure can all increase your risk for FLD, according to the Cleveland Clinic. Although many people with fatty liver aren’t aware of it, it’s estimated to be present in 1 of 4 adults, according to the authors.
Having Both Risk Factors Associated With Less Death Than Having Just One
Investigators recruited 1,569 middle-aged Finnish men without diabetes and followed them for an average of 34 years. Among the subjects, 23.71 percent had FLD, 21.8 percent had hypertension, and 8.54 percent of the men had both. After controlling for age, body mass index (BMI), smoking, and alcohol consumption, researchers found that while both fatty liver disease and hypertension (both separately and combined) were associated a substantial risk of all-cause and cardiovascular death, having both conditions was actually associated with a similar or even lower overall risk than just having hypertension or liver disease. “In this small study, the main finding is that the two cardiovascular risk factors of hypertension and fatty liver disease appear to interact with one another,” says Kristine Owen, MD, an interventional cardiologist and the director of the Cardiac Catheterization Lab at the Charles George VAMC in Asheville, North Carolina, who was not involved with this research. Previously they had been thought to be independent in their interactions, though further research will need to be performed to look at this more closely, she says.
When Both Risk Factors Present, They May Lessen Negative Effects on Heart
The results indicate a negative interaction or “mutual antagonism” between the two risk factors. “That means that while both fatty liver and hypertension contribute to cardiovascular mortality alone, when they coexist, they could block each other’s effect to some extent,” said lead author Mournir Ould Setti, MD, a physician and researcher at the University of Eastern Finland, in a release on August 9. Although it would be premature to draw too many conclusions from these findings, people with both of these risk factors can be reassured that the overall risk for death is not greater than the added individual risks combined, says Dr. Owen. At this point, these findings won’t change recommendations on cardiovascular prevention or treatment, she says. “People with either of these risk factors should be trying to optimize their management and ideally modify their risk profile,” she says.
