Management of cardiovascular risk factors in NAFLD

It is essential to assess and manage cardiovascular risk factors in patients with nonalcoholic fatty liver disease (NAFLD), because they are 3 to 5 times more likely to have a myocardial infarction or stroke, and cardiovascular disease is the most common cause of death.

Note: Aggressive modification of cardiovascular risk factors to reduce the likelihood of myocardial infarction and stroke is an essential part of the management of nonalcoholic fatty liver disease.

Detailed information about assessing and managing cardiovascular risk is available in Therapeutic Guidelines: Cardiovascular—see Atherosclerotic cardiovascular disease risk estimation and Modifiable lifestyle risk factors for atherosclerotic cardiovascular disease.

Manage cardiovascular risk factors as appropriate to the patient, which may include treating hyperlipidaemia with a statin, optimising the glycaemic profile, treating hypertension and encouraging smoking cessation.

Patients with nonalcoholic fatty liver disease who have increased low-density lipoprotein cholesterol (LDL-C) should be strongly considered for statin therapy. It is a common misconception that people with chronic liver disease are more likely to experience liver injury when treated with a statin. Statins are safe in most people with chronic liver disease, but should be used with caution in patients with decompensated liver disease. Lipophilic statins such as atorvastatin or simvastatin are preferred in patients with decompensated liver disease.

Note: Statins are safe in most people with chronic liver disease. Patients with nonalcoholic fatty liver disease who have increased LDL-cholesterol should be strongly considered for statin therapy.

The Royal Australian College of General Practitioners (RACGP) publishes guidance on the management of lifestyle risk factors in general practice: Smoking, nutrition, alcohol and physical activity (SNAP)—see the RACGP website for details.