Nonalcoholic fatty liver disease (NAFLD) and heart failure with preserved ejection fraction (HFpEF) frequently coexist because of shared cardiometabolic risk factors. An observational analysis presented at the Heart Failure 2026 evaluated clinical and metabolic factors associated with HFpEF among patients with NAFLD.

The study included 94 patients with a Fatty Liver Index (FLI) of 60 or greater. Participants were stratified according to echocardiographic findings and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels into patients with HFpEF (n=51) and those without heart failure (n=43). Anthropometric measures and cardiometabolic risk factors were assessed, including obesity, insulin resistance, diabetes, hypertension, and dyslipidemia.

Findings

• Patients with HFpEF were older than those without heart failure (75 ± 6.0 years vs 59 ± 7.7 years; p=0.0001), and women represented a greater proportion of the HFpEF group (78.4% vs 21.6%).
• Serum uric acid levels (342.2 ± 91.7 vs 317.3 ± 90.6; p=0.00006) and HOMA2-IR values (2.77 ± 0.88 vs 2.59 ± 0.70; p=0.002) were higher in patients with HFpEF.
• HDL cholesterol levels were lower in the HFpEF group (1.11 ± 0.28 vs 1.16 ± 0.43; p=0.046).
• Hypertension (43.8% vs 34.9%; p=0.004) and anemia (28% vs 4.7%) occurred more frequently among patients with HFpEF.
• HFpEF in NAFLD was associated with older age (0.960; 95% CI 0.937-0.984; p=0.001), female sex (1.716; 95% CI 1.269-2.163; p=0.00001), higher uric acid levels (0.997; 95% CI 0.996-0.999; p=0.0001), and anemia (1.833; 95% CI 1.702-1.964; p=0.00001).
• Age older than 65 years showed an AUC of 0.841 (p=0.0002), with sensitivity and specificity of 75% for identifying HFpEF.

The findings showed that HFpEF in NAFLD was associated with older age, female sex, higher uric acid levels, and anemia. Higher insulin resistance and hypertension were also more frequently observed in patients with HFpEF.