Bidirectional association between non-steatotic chronic liver disease and heart disease: the potential link of insulin resistance
Authors' conclusion
In this nationally representative longitudinal study, CLD and HD were bidirectionally associated among middle-aged and older adults. IR partially mediated the pathway from HD to CLD, suggesting asymmetric mechanisms underlying liver-heart interactions.
Study context
- Population
- Middle-aged and older adults, China Health and Retirement Longitudinal Study (2011–2020)6,230 free of heart disease (HD)
- Exposure
- Chronic liver disease (CLD) vs no CLD; HD vs no HD
- Outcome
- Incident HD (in those free of HD) and incident CLD (in those without CLD)
Methodological detailsnationally representative, bidirectional analysis, mediation analysis, five waves 2011–2020
- Nationally representative
- Bidirectional analysis
- Mediation analysis
- Five waves 2011–2020
Main finding
As reported in the abstract
Incident HD and incident CLD
Hazard ratio (95% CI)
CLDvs No CLDincident HD; 6,230 free of HD at baseline
1.803(1.376–2.362)
HDvs No HDincident CLD; 6,917 without baseline CLD
2.303(1.813–2.924)
Observational data: associations, not effects.
Further findings
Subgroup and sensitivity analyses
- Associations consistent across predefined subgroups and sensitivity analyses
Mediation by insulin resistance (IR) (triglyceride-glucose (TyG) index, metabolic score for IR (METS-IR))
- TyG index and METS-IR partially mediated HD → incident CLD, but not CLD → incident HD
Original publication
Bidirectional association between non-steatotic chronic liver disease and heart disease: the potential link of insulin resistance. Cardiovasc Diabetol. Published 21 March 2026. doi:10.
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