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World J Hepatol. Jul 27, 2018; 10(7): 474-478
Published online Jul 27, 2018. doi: 10.4254/wjh.v10.i7.474
Associations between nonalcoholic fatty liver disease and ischemic stroke
Stelina Alkagiet, Achilleas Papagiannis, Konstantinos Tziomalos
Stelina Alkagiet, Achilleas Papagiannis, Konstantinos Tziomalos, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece
Author contributions: Alkagiet S and Papagiannis A drafted the review; Tziomalos K critically revised the draft.
Conflict-of-interest statement: All authors declare no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Konstantinos Tziomalos, MD, PhD, Assistant Professor, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, Thessaloniki 54636, Greece. ktziomalos@yahoo.com
Telephone: +30-2310-994621 Fax: +30-2310-994773
Received: March 27, 2018
Peer-review started: March 28, 2018
First decision: April 13, 2018
Revised: April 22, 2018
Accepted: May 30, 2018
Article in press: May 31, 2018
Published online: July 27, 2018
Processing time: 121 Days and 10.6 Hours
Abstract

Nonalcoholic fatty liver disease (NAFLD) is the commonest chronic liver disease and affects a considerable proportion of the general population. NAFLD is independently associated with increased risk for cardiovascular events, particularly coronary heart disease. Importantly, even though NAFLD is more prevalent in patients with major cardiovascular risk factors (e.g., type 2 diabetes mellitus, obesity and hypertension), the association between NAFLD and cardiovascular disease appears to be independent of these risk factors. However, NAFLD also appears to increase the risk for ischemic stroke, a leading cause of mortality and long-term disability worldwide. It also appears that nonalcoholic steatohepatitis is more strongly related to the risk of ischemic stroke than isolated hepatic steatosis. Moreover, emerging data suggest that patients with NAFLD experience more severe ischemic stroke and have more unfavorable prognosis after an acute ischemic stroke in terms of functional dependency and short- and long-term mortality. These associations have major public health implications, since ischemic stroke is the second leading cause of death worldwide and an important cause of long-term disability. The aim of the present review is to summarize the current knowledge regarding the relationship between NAFLD and ischemic stroke incidence, severity and outcome. Given these associations, it might be useful to evaluate patients with acute ischemic stroke for the presence of NAFLD and to manage those with NAFLD more aggressively.

Keywords: Nonalcoholic fatty liver disease; Ischemic stroke; Risk; Incidence; Severity; Outcome; Functional dependency

Core tip: Accumulating data suggest that nonalcoholic fatty liver disease (NAFLD) is independently associated with increased risk for ischemic stroke, a leading cause of mortality and long-term disability worldwide. Moreover, emerging evidence shows that patients with NAFLD experience more severe ischemic stroke and have more unfavorable prognosis after an acute ischemic stroke in terms of functional dependency and short- and long-term mortality.