Heart and Soul

NAFLD has been long associated with cardiovascular risk factors and cardiovascular death, but the impracticality of serial liver biopsy has limited large-scale studies of the incidence and progression of NAFLD fibrosis. Long et al. used vibrationcontrolled transient elastography (or FibroScan) to evaluate fibrosis in a large cohort within the Framingham Heart Study. They found a ~10% prevalence of liver fibrosis and a clear association with cardiometabolic factors such as diabetes (OR, 4.48) and obesity (OR, 3.11). Although the cross-sectional design cannot assess progression or adjudicate the bidirectional interaction between cardiometabolic factors and liver disease, it confirms previous data using a strong representative cohort and a wellestablished, noninvasive diagnostic tool. Longitudinal studies are needed to better assess the interplay of these factors and their impact on outcomes. (Hepat ology 2021;73:548-559).