Fatty Liver and Your Heart: Understanding the Hidden Connection Between NAFLD and Cardiovascular Disease

Table of Contents

• Key Points
• What Is Nonalcoholic Fatty Liver Disease?
• How This Research Review Was Conducted
• How Common Is Heart Disease in NAFLD Patients?
• Why Does Fatty Liver Harm Your Heart?
• Heart Conditions Linked to NAFLD
• Screening and Diagnosis: What You Should Know
• Treatment and Management Options
• Study Limitations: What This Review Couldn't Prove
• Recommendations for Patients
• Frequently Asked Questions
• Source Information

Key Points

• 1 in 4 people worldwide have NAFLD, and heart disease is the leading cause of death in these patients.
• A meta-analysis of 165,000 people found NAFLD raises odds of existing cardiovascular disease by 81%.
• Fatty liver causes systemic inflammation, endothelial dysfunction, insulin resistance, and oxidative stress that damage blood vessels.
• NAFLD is linked to high blood pressure, coronary artery disease, and atrial fibrillation, independent of traditional risk factors.
• Sustained weight loss of at least 10% is the mainstay treatment for NAFLD and lowers cardiovascular risk.

What Is Nonalcoholic Fatty Liver Disease?

Nonalcoholic fatty liver disease (NAFLD) is a progressive condition that affects the liver — the large organ in your upper right abdomen responsible for filtering toxins, producing bile, and regulating metabolism. The term "NAFLD" describes a spectrum of liver damage that occurs without alcohol as the cause. It ranges from simple steatosis (fat accumulation in more than 5% of liver cells without injury) to nonalcoholic steatohepatitis (NASH, where fat is accompanied by inflammation), then to fibrosis (excessive scar tissue), and finally cirrhosis (advanced scarring that distorts the liver's structure and blood flow).

You might also hear NAFLD called metabolic dysfunction-associated fatty liver disease (MAFLD), a newer name that reflects its close ties to metabolic problems like obesity and diabetes.

Doctors diagnose NAFLD only after excluding other causes of liver disease, such as alcohol. It is now considered the liver-based manifestation of metabolic syndrome (MetS) — a cluster of conditions that increase your risk for heart disease, stroke, and diabetes. Metabolic syndrome is diagnosed when you have three or more of these five conditions:

• High blood glucose (blood sugar)
• Low levels of high-density lipoprotein (HDL), the "good" cholesterol
• High blood triglycerides (a type of fat in the blood)
• High blood pressure
• Large waist circumference (the "apple-shaped" body type)

How Does NAFLD Develop?

Scientists describe NAFLD development using the "multiple-hit" hypothesis. The "first hit" is the accumulation of fatty acids inside liver cells, which makes those cells more vulnerable to secondary insults. Subsequent "hits" include insulin resistance (when your cells stop responding properly to insulin), oxidative stress (damage from unstable molecules called free radicals), apoptosis (programmed cell death), and abnormal signals from fat tissue hormones (adipokines). A review by Buzzetti and colleagues emphasized that NAFLD results from the cumulative effect of many factors acting together — insulin resistance, nutritional factors, gut bacteria (microbiota), and both genetic and epigenetic influences.

Who Gets NAFLD?

NAFLD is now the most common liver disease in the world, affecting roughly a quarter of the global population. Regional differences are striking: the Middle East and South America have the highest prevalence, while Africa has the lowest.

The condition is especially common in high-risk groups:

• More than 95% of patients with severe obesity who undergo bariatric (weight-loss) surgery
• One-third to two-thirds of patients with type 2 diabetes
• About half of patients with dyslipidemia (abnormal cholesterol or fat levels in the blood)
• Only 10% to 15% of normal-weight individuals

In the United States, NAFLD affects 20% to 30% of the population, with higher rates among men, Hispanic Americans, and older adults. Well-established risk factors include obesity, type 2 diabetes mellitus (T2DM), dyslipidemia, metabolic syndrome, and polycystic ovary syndrome (PCOS). Emerging research also links NAFLD to hypothyroidism (underactive thyroid), obstructive sleep apnea, hypopituitarism, hypogonadism (low sex hormones), and psoriasis.

Why Should You Care?

NAFLD is often called a "silent" disease because it produces few or no symptoms. Many patients discover they have it incidentally — through abnormal liver enzyme tests on routine blood work or a fatty liver seen on an ultrasound done for another reason. In fact, a large proportion of NAFLD patients have normal liver enzyme levels, or levels only slightly above normal.

Simple steatosis generally has a good outlook. However, NASH can progress to cirrhosis and liver cancer (hepatocellular carcinoma, HCC) in 10% to 15% of cases. NASH is now the fastest-growing reason for liver transplantation in the United States. But here's the critical point: NAFLD is not just a liver disease. It's a multi-system illness. The number one cause of death in NAFLD patients is cardiovascular disease, responsible for 40% of all deaths — not liver failure. This surprising fact is the focus of the review you're about to explore.

How This Research Review Was Conducted

The authors of this review searched PubMed (the National Library of Medicine's database of biomedical research) in April 2022 using the medical subject headings (MeSH) "nonalcoholic fatty liver disease" AND "cardiovascular diseases." They focused on articles published over a 20-year span, from 2002 to 2022.

Their search gathered evidence from a wide range of study types:

• Observational studies: 2 case-control studies, 14 cohort studies, and 24 cross-sectional studies
• Clinical trials: 3 randomized controlled trials (RCTs)
• Evidence syntheses: 3 systematic reviews, 1 meta-analysis, and 4 systematic reviews with meta-analyses
• Expert and lay resources: 45 narrative reviews, 1 case series, 2 consensus statements from international experts, 1 joint workshop discussion, 2 patient pages from medical journals, 4 prominent health websites, 2 guidance documents, and 1 clinical guideline

Because this is a narrative review — not a single new experiment — its conclusions synthesize findings across many existing studies. This approach is valuable for painting a broad picture, especially for a topic as complex as the NAFLD–CVD connection.

How Common Is Heart Disease in NAFLD Patients?

The numbers from this review are eye-opening. Multiple large studies confirm that NAFLD independently raises your risk for cardiovascular disease — even after accounting for traditional risk factors like high cholesterol, smoking, and high blood pressure.

The Wide-Angle View: A Meta-Analysis of 165,000 People

A large meta-analysis by Wu and colleagues pooled data from 34 studies and 165,000 participants across the globe. The results showed that NAFLD was associated with:

• 81% higher odds of having cardiovascular disease at the time of the study (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 1.23–2.66)
• 37% higher risk of developing new cardiovascular events during follow-up (hazard ratio [HR]: 1.37; 95% CI: 1.10–1.72)
• 87% higher odds of existing coronary artery disease (CAD) (OR: 1.87; 95% CI: 1.47–2.37) and a 2.31-fold higher risk of developing CAD (HR: 2.31; 95% CI: 1.46–3.65)
• 24% higher odds of high blood pressure (OR: 1.24; 95% CI: 1.14–1.36) and a 16% higher risk of developing hypertension (HR: 1.16; 95% CI: 1.06–1.27)
• 32% higher odds of atherosclerosis — hardening and narrowing of the arteries (OR: 1.32; 95% CI: 1.07–1.62)

In plain language: if you have a fatty liver, your chance of having or developing heart and blood vessel disease is dramatically higher than someone without NAFLD — and this holds true even when other risk factors are taken into account.

Long-Term Follow-Up Confirms the Danger

A meta-analysis by Targher and colleagues pooled 16 observational studies (9 prospective and 7 retrospective cohort studies) involving 34,043 patients with a median follow-up of 7 years. The headline finding: NAFLD patients had a 64% higher risk of developing fatal or non-fatal cardiovascular events (OR: 1.64; 95% CI: 1.26–2.13) compared to those without NAFLD.

A Swedish cohort study of 229 patients with biopsy-proven NAFLD followed for an average of 26.4 years found striking increases in mortality:

• 55% higher risk of dying from cardiovascular disease (HR: 1.55; CI: 1.11–2.15; p=0.01)
• 3.2 times higher risk of dying from cirrhosis (HR: 3.2; CI: 1.05–9.81; p=0.041)
• 6.55 times higher risk of dying from liver cancer (HR: 6.55; CI: 2.14–20.03; p=0.001)

What Do Patients Actually Die From?

Two large mortality studies paint a dramatic picture:

In the United States, an analysis of a national database covering 2,826,531 deaths in 2018 found that among patients with NAFLD, heart disease mortality (10.33%) ranked as the second leading cause of death — just behind liver-related mortality (45.83%).

In southern China, a multicenter retrospective study covering 10,071 hospital deaths from 2009 to 2018 found the opposite pattern: cardiovascular mortality (35.6%) ranked first, far exceeding liver-related mortality (5.2%), which ranked only fifth.

These numbers reinforce a vital message: NAFLD is not merely a "liver problem." It's a cardiovascular risk factor that demands attention from your heart doctor as much as your liver specialist.

The Framingham Heart Study Connection

Analysis of 1,051 Framingham Heart Study participants followed for six years found that those with increased liver fat had substantially higher risks of developing hypertension (OR: 1.42; p<0.001) and type 2 diabetes (OR: 1.43; p<0.001). The relationship was bidirectional — fatty liver predicted heart risk factors, and heart risk factors predicted fatty liver — creating a dangerous feedback loop among middle-aged and older adults.

Using the Fatty Liver Index to Predict Ten-Year Risk

A Korean population study used the fatty liver index (FLI), a score calculated from waist circumference, body mass index, triglycerides, and a liver enzyme called gamma-glutamyltransferase (GGT). People with hepatic steatosis (FLI ≥ 60) had 2.56 times higher odds (OR: 2.56; 95% CI: 1.97–3.33) of having a high Framingham 10-year cardiovascular risk (≥10%) compared to those without fatty liver (FLI < 30), even after adjusting for other factors.

Why Does Fatty Liver Harm Your Heart?

NAFLD and cardiovascular disease share many risk factors through metabolic syndrome. But the connection goes deeper — NAFLD itself appears to damage the cardiovascular system through multiple biological pathways. The review identifies these key mechanisms:

• Systemic inflammation: A fatty liver releases inflammatory molecules into the bloodstream that affect the whole body.
• Endothelial dysfunction: The delicate inner lining of your blood vessels (the endothelium) stops functioning properly, impairing its ability to regulate blood flow and clot formation.
• Hepatic insulin resistance: When the liver stops responding to insulin properly, blood sugar and fat metabolism go awry, cascading into metabolic damage throughout the body.
• Oxidative stress: Excess free radicals damage cells and tissues, including blood vessel walls.
• Altered lipid metabolism: The liver produces abnormal levels of fats and cholesterol, promoting plaque buildup in arteries.

Experimental studies also show that NAFLD promotes cardiovascular disease through glucose and lipid dysregulation, imbalances in the immune and neuroendocrine (hormone) systems, and activation of the prothrombotic system — meaning the blood becomes more prone to clotting. Additional mechanisms include activation of the renin-angiotensin pathway (a hormone system that regulates blood pressure), intestinal dysbiosis (an unhealthy imbalance of gut bacteria), and genetic and epigenetic factors.

The end result is damage to the structure, function, and electrical activity of the cardiovascular system. This predisposes NAFLD patients to hypertension (high blood pressure), atherosclerosis (artery hardening), arrhythmias (irregular heartbeats), myocardial dysfunction (impaired heart muscle pumping), cardiac valve deformation, and venous thrombosis (blood clots in veins).

Visible markers of this damage include endothelial dysfunction, rapid pulse wave velocity (a measure of artery stiffness), coronary artery calcification, and increased carotid artery wall thickness — all measurable signs your doctor can check.

Heart Conditions Linked to NAFLD

The review breaks down the cardiovascular complications of NAFLD into three main categories. These are the conditions patients and doctors should watch for most closely.

1. High Blood Pressure (Arterial Hypertension)

High blood pressure is the most common treatable risk factor for cardiovascular disease, and it's strongly intertwined with NAFLD. According to the World Health Organization (WHO), high blood pressure causes approximately 54% of all strokes and 47% of all ischemic heart disease events worldwide.

Both prehypertension (slightly elevated blood pressure) and full hypertension are substantial risk factors for having NAFLD, regardless of other cardiometabolic risk factors. Importantly, controlled blood pressure appears protective against NAFLD, particularly in non-obese people. People with controlled or no high blood pressure also have a lower likelihood of developing moderate-to-severe liver fibrosis.

European studies reinforce this link. In prospective studies from France and Germany with observation periods of nine and five years, researchers found a 2-to-3-fold increase in the prevalence of arterial hypertension among people with baseline markers of fatty liver (elevated GGT and fatty liver index). The development of hypertension was predicted by hepatic insulin resistance, suggesting a direct liver–blood pressure connection.

Research by Lau and colleagues found that fatty liver disease, identified by liver hyperechogenicity (increased brightness on ultrasound) and elevated ALT liver enzyme levels, is linked to rising blood pressure and new-onset hypertension — regardless of alcohol consumption. The authors recommend that people with these findings have their blood pressure checked regularly and adopt lifestyle changes including better nutrition, physical exercise, and moderation of alcohol intake.

In the Finnish OPERA study (Oulu Project Elucidating Risk of Atherosclerosis), the 24-hour, daytime, and night-time mean values of systolic and diastolic blood pressure were all significantly higher in people with fatty liver on ultrasound compared to those without. The association with "non-dipping" status (a pattern where blood pressure doesn't fall normally at night) showed only a trend toward significance (30.9% vs. 24.6%; p=0.057).

What this means for you: If you have fatty liver, your blood pressure deserves close monitoring. If medication is needed, choose options with minimal metabolic side effects. Some experts suggest that 24-hour ambulatory blood pressure monitoring may be especially valuable for people with fatty liver, since office readings alone may miss nighttime elevations.

2. Coronary Artery Disease (CAD)

Coronary artery disease occurs when plaque builds up in the arteries that supply blood to your heart muscle. The review found strong evidence linking NAFLD to both silent (subclinical) and symptomatic CAD.

A meta-analysis by Jaruvongvanich and colleagues found a substantial positive relationship between NAFLD and coronary artery calcium (CAC) — a calcium score detected on CT scans that indicates the presence of plaque. CAC testing may help identify NAFLD patients at greater risk for future heart events.

Another meta-analysis by Haddad and colleagues confirmed that NAFLD is linked to an elevated risk of cardiovascular events, CAD, and stroke. The authors suggest that because active hepatitis (inflammation) may add further risk, it's wise to assess all NAFLD patients for cardiovascular risk factors and hidden (occult) heart disease, then start risk-reduction therapy — such as diet changes and statins — as early as possible.

Osawa and colleagues used advanced CT imaging to show that nonalcoholic hepatic steatosis (fatty liver), measured by the liver-to-spleen fat attenuation ratio, is substantially connected with coronary artery plaques — particularly high-risk plaques prone to rupture. This makes NAFLD a potentially useful predictor of acute coronary syndrome (ACS), the umbrella term for heart attacks and unstable angina.

Keskin and colleagues studied patients with STEMI (ST-elevation myocardial infarction, the most severe type of heart attack) and found that NAFLD and its severity independently influenced both clinical outcomes and the severity of CAD as measured by the SYNTAX score (a tool that grades coronary artery complexity). Patients with grade 3 NAFLD (the most severe) had higher rates of in-hospital death, stent thrombosis (blood clots in stents), and long-term mortality. This points to the importance of screening for NAFLD in heart attack patients.

3. Heart Rhythm Problems (Cardiac Arrhythmias)

Growing evidence links NAFLD to abnormal heart rhythms. Even when other cardiovascular risk factors and metabolic syndrome features are accounted for, NAFLD is closely associated with atrial fibrillation (AF) — a common irregular heartbeat that increases stroke risk — as well as QTc prolongation (a delay in the heart's electrical recharging cycle) and ventricular arrhythmias (dangerous rhythms arising from the lower chambers of the heart).

These rhythm disturbances may partly explain why people with NAFLD have a higher risk of cardiovascular death.

In the study by Käräjämäki and colleagues, researchers found significant epidemiological evidence that NAFLD is an independent risk factor for atrial fibrillation. Mantovani and colleagues published the first study of its kind to demonstrate a positive and independent link between NAFLD and ventricular arrhythmias in patients with type 2 diabetes who underwent clinically recommended 24-hour Holter monitoring (a portable device that records every heartbeat). Targher and colleagues were the first to show that ultrasound-diagnosed NAFLD is associated with an increased incidence of atrial fibrillation in diabetic patients.

What this means for you: If you have NAFLD — especially if you also have diabetes — mention any palpitations, fluttering, dizziness, or fainting to your doctor. These could be signs of an arrhythmia that warrants cardiac monitoring.

Screening and Diagnosis: What You Should Know

Despite being a major and rapidly growing risk factor for heart disease, NAFLD remains overlooked and undetected compared to traditional risk factors like high cholesterol or smoking. The authors of this review strongly recommend that NAFLD patients receive comprehensive cardiovascular screening as a routine part of their care.

Recommended monitoring includes:

Metabolic Biomarkers (Blood Tests)

• Glucose (blood sugar)
• Glycosylated hemoglobin (HbA1c) — a measure of average blood sugar over the past 2–3 months
• Insulin levels
• Lipids and lipoproteins (cholesterol panel, including LDL, HDL, and triglycerides)

Cardiovascular Risk Scores

• American College of Cardiology/American Heart Association (ACC/AHA) risk calculator
• Framingham Risk Score — the classic 10-year risk estimate for heart events

Tests for Subclinical Atherosclerosis

• Coronary artery calcification (CAC) score — a CT scan that quantifies calcium deposits in heart arteries
• Carotid intima-media thickness (CIMT) — an ultrasound measurement of the thickness of the inner two layers of the carotid artery in your neck
• Carotid plaque assessment — an ultrasound to look for plaque buildup in the carotid arteries

These tests can catch cardiovascular damage before symptoms appear — a critical advantage, since NAFLD is so often silent.

Treatment and Management Options

There is currently no universally accepted medical treatment for NAFLD itself. But there is a very effective "treatment" that patients can prescribe for themselves, with medical guidance: lifestyle change.

The Power of Weight Loss

Lifestyle modification with weight loss of at least 10% of body weight is the mainstay of NAFLD management. This degree of weight loss has been shown to reduce liver fat, improve inflammation, and — critically — lower cardiovascular risk.

Medication Options

The review notes that combination therapy with ezetimibe and statins (two classes of cholesterol-lowering medications) has a cardioprotective effect and can help reduce liver fat. Ezetimibe works by reducing cholesterol absorption from your intestine, while statins work primarily by blocking cholesterol production in the liver. This combination may be especially valuable for NAFLD patients who are at elevated cardiovascular risk.

Other Management Strategies

Because NAFLD is so closely tied to metabolic syndrome, management must address all its components:

• Blood pressure control: Choose antihypertensive medications with minimal metabolic side effects
• Diabetes management: Tight glucose control to reduce the synergistic effects of T2DM and NAFLD
• Dyslipidemia treatment: Statins (and ezetimibe when needed) to manage cholesterol and reduce liver fat
• Bariatric surgery: For patients with severe obesity, this remains the most effective way to achieve dramatic, sustained weight loss

Health literacy and patient education are also central. The authors emphasize that many patients simply don't know they have NAFLD or understand its cardiovascular implications. Education about the connection between fatty liver and heart disease is the first step toward prevention.

Study Limitations: What This Review Couldn't Prove

This review synthesizes existing research rather than conducting new experiments, and it has important limitations that patients should understand:

• Heterogeneity: The underlying studies varied widely in design, patient populations, diagnostic methods for NAFLD (biopsy, ultrasound, blood scores), and definition of cardiovascular outcomes.
• Residual confounding: Even after statistical adjustments, unknown or unmeasured factors could partly explain the link between NAFLD and CVD.
• Selection bias: Many studies recruited patients from liver specialty clinics, who tend to have more advanced disease and therefore higher risk than the general NAFLD population.
• Missing data: Some studies lacked clinical information about their reference (comparison) populations, and some cardiovascular events may not have been captured.
• Causation vs. association: While most studies conclude that NAFLD is closely associated with adverse cardiovascular events, the causal relationship — whether NAFLD directly causes heart disease or merely occurs alongside it — remains an open question. The authors note that ongoing debate persists in the medical community.

Importantly, the authors call for well-designed large prospective studies across multiple ethnic groups to confirm the link and demonstrate causation, particularly for outcomes like stroke and arrhythmias.

Recommendations for Patients

Based on this review, here is practical advice for people living with NAFLD — or who want to avoid it:

1. Find out if you have NAFLD. If you have obesity, diabetes, abnormal cholesterol, or metabolic syndrome, ask your doctor about screening with liver enzyme tests and imaging (typically ultrasound). Fatty liver can be present even with normal blood tests.
2. Get a full cardiovascular risk assessment. This should include blood pressure measurement, a lipid panel, blood sugar and HbA1c, and a formal risk calculation using the ACC/AHA or Framingham tools. In selected patients, a CAC score or carotid ultrasound may add valuable information.
3. Monitor your blood pressure at home. The connection between fatty liver and high blood pressure is strong, and nighttime blood pressure elevations may be missed in the doctor's office. Ask your doctor if home or 24-hour ambulatory monitoring is right for you.
4. Take cholesterol medications seriously. The combination of a statin plus ezetimibe may both protect your heart and reduce liver fat. If your doctor prescribes these, take them consistently.
5. Pursue weight loss as medical treatment. Aim for at least 10% weight loss through sustainable changes to your diet and physical activity. This is the single most powerful intervention for both NAFLD and cardiovascular risk.
6. Watch for heart rhythm symptoms. Palpitations, fluttering, lightheadedness, or unexplained fatigue warrant prompt medical attention. NAFLD — especially with diabetes — raises your risk of atrial fibrillation and other arrhythmias.
7. Educate yourself and your family. NAFLD is common (affecting a quarter of the world's population), but it's a relatively modern and under-recognized risk factor for heart disease. Being an informed patient can make a life-saving difference.
8. Advocate for comprehensive care. Ensure your doctors are looking at both your liver and your heart. A gastroenterologist or hepatologist for liver care plus a cardiologist for heart risk management is often ideal.

The takeaway message from this review is direct and powerful: NAFLD is not just about the liver — it's a heart disease risk factor that deserves the same attention we give to blood pressure, cholesterol, and smoking. With early detection, diligent monitoring, and lifestyle changes, much of the cardiovascular risk associated with NAFLD can be reduced or even reversed.

Frequently Asked Questions

What is nonalcoholic fatty liver disease and is it dangerous?

NAFLD is a liver condition with fat buildup not caused by alcohol, ranging from simple fat to inflammation, scarring, and cirrhosis. It is often silent. While liver problems matter, heart disease is actually the leading cause of death in NAFLD patients, responsible for 40% of all deaths.

Why does a fatty liver harm my heart?

A fatty liver releases inflammatory molecules into the blood, impairs blood vessel lining function, causes insulin resistance, and creates oxidative stress. These changes promote high blood pressure, artery hardening, irregular heartbeats, and blood clots, damaging the structure and function of your heart and blood vessels.

Which heart conditions are most strongly linked to NAFLD?

The review links NAFLD to three main categories: high blood pressure, coronary artery disease including heart attacks, and heart rhythm problems like atrial fibrillation. Even after accounting for traditional risk factors, people with fatty liver have higher rates of these conditions.

I have been diagnosed with fatty liver. What heart screenings should I ask for?

Ask your doctor for blood pressure checks, lipid panel, blood sugar and HbA1c, and a formal heart risk score like ACC/AHA or Framingham. In selected cases, a coronary calcium CT scan or carotid ultrasound can catch silent artery damage before symptoms appear.

Can losing weight really improve my fatty liver and heart risk?

Yes. Lifestyle changes leading to at least 10% weight loss are the main treatment for NAFLD. This degree of weight loss has been shown to reduce liver fat, improve inflammation, and lower cardiovascular risk. It is considered the most powerful intervention for both conditions.

Do cholesterol medications help if I have fatty liver?

The review notes that combining ezetimibe with a statin has a heart-protective effect and can help reduce liver fat. Statins block cholesterol production in the liver, while ezetimibe reduces cholesterol absorption from your intestine. Take these exactly as prescribed if your doctor recommends them.

Source Information

Original article title: Nonalcoholic Fatty Liver Disease- An Emerging Modern-Day Risk Factor for Cardiovascular Disease

Authors: Gashaw Hassen, Abhishek Singh, Gizeshwork Belete, Nidhi Jain, Ivonne De la Hoz, Genesis P. Camacho-Leon, Nitsuh K. Dargie, Keila G. Carrera, Tadesse Alemu, Sharan Jhaveri, Nebiyou Solomon

Corresponding author: Gashaw Hassen, dr.gashaw@yahoo.com

Publication details: Cureus 14(5): e25495. Published May 30, 2022. DOI: 10.7759/cureus.25495. Received May 2, 2022; review began May 11, 2022; review ended May 12, 2022.

Article type: Open Access Review Article (Categories: Cardiology, Internal Medicine, Gastroenterology)

The original article is distributed under the terms of the Creative Commons Attribution License CC-BY 4.0, which permits unrestricted use, distribution, and reproduction in any medium.

Note: This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and does not replace personalized medical advice. Always consult your healthcare provider about your specific health situation.